Senate Engrossed House Bill

claims; prior authorization; conduct

(now:  prior authorization; claims)

State of Arizona

House of Representatives

Fifty-seventh Legislature

First Regular Session

2025

CHAPTER 165

HOUSE BILL 2175

AN ACT

amending title 20, chapter 20, article 1, arizona revised statutes, by adding section 20-3103; amending title 20, chapter 26, article 1, Arizona Revised Statutes, by adding section 20-3407; relating to insurance.

(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; review of claims

Before a health care insurer may deny a claim that was submitted by a provider on the basis of medical necessity, the medical director shall individually review the denial. During each individual review, the medical director shall exercise independent medical judgment and may not rely solely on recommendations from any other source. END_STATUTE

Sec. 2. Title 20, chapter 26, article 1, Arizona Revised Statutes, is amended by adding section 20-3407, to read:

START_STATUTE20-3407. Denial of prior authorization; review of prior authorization

Before a health care insurer may issue a direct denial of a prior authorization of a service that was requested by a provider and that involves medical necessity, the medical director shall individually review the denial. During each individual review, the medical director shall exercise independent medical judgment and may not rely solely on recommendations from any other source. END_STATUTE

Sec. 3. Effective date

This act is effective from and after June 30, 2026.

APPROVED BY THE GOVERNOR MAY 12, 2025.

FILED IN THE OFFICE OF THE SECRETARY OF STATE MAY 12, 2025.