ARIZONA HOUSE OF REPRESENTATIVES Fifty-seventh Legislature First Regular Session
	House: APPROP DPA 17-0-0-1

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HB 2874: excessive health insurance claims; notification

Sponsor: Representative Liguori, LD 5

House Engrossed

Overview

Directs a health care insurer to notify the Department of Insurance and Financial Institutions (DIFI) and the applicable certification board if the insurer notices that the number of health care insurance claims filed by the provider for patient services on any given workday that exceeds the number of patients the provider could reasonably be expected to treat on that given workday.

History

DIFI is a multifaceted agency that regulates the insurance industry, financial institutions and enterprises. DIFI regulates such industries through licensure of financial and insurance professionals such as collection agencies, mortgage bankers and brokers, insurers and insurance producers, registering and certifying state-chartered banks and credit unions and conducting scheduled examinations and investigating complaints of licensed professionals and businesses (A.R.S. § 20-142).

Any person or other entity that provides coverage in this state for medical, surgical, chiropractic, naturopathic medicine, occupational therapy, physical therapy, speech pathology, audiology, professional mental health, dental, hospital or optometric expense, whether the coverage is by direct payment, reimbursement or otherwise, is presumed to be under the jurisdiction of DIFI unless the person or other entity shows that while providing coverage it is under the jurisdiction of another agency of this state, this state itself or any other state or the federal government (A.R.S. § 20-115).

Provisions

1. Requires a health care insurer that notices a trend in the number of health care insurance claims filed by a provider for patient services on any given workday that exceeds the number of patients the provider could reasonably be expected to treat on that given workday to notify:

a) DIFI; and

b) the board that licenses, registers or certifies the provider. (Sec. 1)

2. Requires a property or casualty insurer that notices claim activities that suggest possible insurance or health care fraud to notify DIFI and the applicable board that licenses, registers or certifies the health care provider. (Sec. 1)

3. Defines health care provider as a person who is licensed, registered or certified as a health care profession under state law. (Sec 1)

4. Defines health care insurer as a disability insurer, group disability insurer, blanket disability insurer, health care services organization, hospital service organization or medical service corporation. (Sec. 1) 

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                  HB 2874

Initials JB            Page 0 House Engrossed

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