If enacted, this bill would amend current statutes by adding new requirements for health care insurers regarding the denial of claims and prior authorizations. Specifically, it would mandate that a health care provider or medical director must individually review each claim or prior authorization that involves medical necessity, experimental status, or requires medical judgment before a denial can be issued. This requirement aims to ensure that decisions are made based on thorough individual assessments rather than solely on external recommendations. Additionally, the bill introduces a provision that classifies the denial of a claim or prior authorization without such an individual review as an act of unprofessional conduct.

The bill also clarifies the definition of a "health care provider" to include individuals certified or licensed under various titles in Arizona, as well as those holding similar licenses from other states. Furthermore, it explicitly states that artificial intelligence cannot be used to deny claims or prior authorizations related to medical necessity or other judgments requiring medical expertise. These changes are set to take effect on July 1, 2026, thereby updating the existing legal framework governing health care insurance claims and prior authorizations.

Statutes affected:
Introduced Version: 20-3103
House Engrossed Version: 20-3103