This bill proposes to amend the Arizona Revised Statutes by adding a new section, 36-2903.18, which specifically addresses the appeals process for behavioral health claims under the Arizona health care cost containment system. The new language stipulates that any appeal related to a behavioral health claim that falls under the capped fee-for-service schedule must be reviewed by an individual with relevant clinical experience.

Currently, there are no specific requirements regarding the qualifications of individuals reviewing such appeals, which may lead to inconsistencies in the appeals process. The insertion of this new requirement aims to ensure that appeals are handled by qualified professionals, thereby potentially improving the fairness and effectiveness of the review process for behavioral health claims.

Statutes affected:
Introduced Version: 36-2903.18