REFERENCE TITLE: claims; prior authorization; conduct

State of Arizona

House of Representatives

Fifty-seventh Legislature

First Regular Session

2025

HB 2175

Introduced by

Representative Willoughby

AN ACT

amending title 20, chapter 20, article 1, arizona revised statutes, by adding section 20-3103; relating to timely PAYMENT of health care insurance claims.

(TEXT OF BILL BEGINS ON NEXT PAGE)

Be it enacted by the Legislature of the State of Arizona:

Section 1. Title 20, chapter 20, article 1, Arizona Revised Statutes, is amended by adding section 20-3103, to read:

START_STATUTE20-3103. Denial of claims or prior authorization; health care provider review; unprofessional conduct; definition

A. Except for denials for lack of administrative completeness, member enrollment status or a determination that a service or provider type is categorically excluded from coverage under the plan, a health care provider shall individually review each claim for health care services before a health care insurer denies a claim or a prior authorization.  Artificial intelligence may not be used to deny a claim or a prior authorization.

B. A health care provider that denies a claim or a prior authorization without an individual review of the claim or prior authorization commits an act of unprofessional conduct.

C. For the purposes of this section, "health care provider" means a person who is certified or licensed pursuant to title 32, chapter 7, 8, 11, 13, 14, 15, 15.1, 16, 17, 18, 19, 19.1, 21, 25, 28, 29, 33, 34, 35, 39, 41 or 42, title 36, chapter 4, article 6, title 36, chapter 6, article 7 or title 36, chapter 17. END_STATUTE