This bill establishes a mandatory peer-to-peer review process for insurance carriers during the prior authorization of medical services. It requires that when a utilization review entity requests prior authorization, healthcare providers must have the opportunity to discuss the authorization request directly with a medical director or designated clinical peer. The bill defines a "clinical peer" as someone actively practicing in a similar specialty and allows for these reviews to be requested both before and after a denial of prior authorization. Insurers are also required to disclose the credentials of the reviewer, including their full name, licensure type, and National Provider Identifier (NPI), prior to the review conversation. The peer-to-peer review must be scheduled within five business days of the request, and non-compliance with these requirements may be deemed an unfair insurance practice.

Additionally, the bill introduces new legal language concerning medical loss ratio requirements, which could impact the profitability of insurance carriers and their participation in the New Hampshire insurance market. While the bill aims to enhance transparency and communication between providers and insurers, it may also lead to increased administrative costs for health carriers. The potential effects on health insurance premiums for counties and municipalities are acknowledged, but the Department has indicated it cannot estimate the administrative costs or changes in business strategies that carriers may face due to these new requirements. Overall, while the bill includes significant changes, specific insertions and deletions in the legal language are not detailed in the provided text.

Statutes affected:
Introduced: 420-E:4-b, 420-J:6
As Amended by the House: 420-E:4-b, 420-J:6
As Amended by the Senate: 420-E:4-b, 420-J:6
HB1554 text: 420-E:4-b, 420-J:6