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ARIZONA HOUSE OF REPRESENTATIVES57th Legislature, 2nd Regular Session |
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HB 2194: claims; prior authorization; denials; contact
Sponsor: Representative Bliss, LD 1
Committee on Health & Human Services
Overview
Effective July 1, 2027, requires a health care insurer that denies a claim or prior authorization for any reason to provide the contact information of a department that can provide a detailed explanation and a substantive response to questions about why the claim or prior authorization was denied.
History
Health care insurer means a disability insurer, group disability insurer, blanket disability insurer, health care services organization, prepaid dental plan organization, hospital service corporation, medical service corporation, dental service corporation, optometric service corporation or hospital, medical, dental and optometric service corporation. Clean claims are written or electronic claims for health care services or benefits that may be processed without obtaining additional information, including coordination of benefits information, from the health care provider, the enrollee or a third party, except in fraud cases (A.R.S. § 20-3101).
Statute outlines the process for timely payment of health care provider's claims and to address grievances. Specifically, health care insurers must adjudicate any clean claim from a contracted or noncontracted health care provider relating to health care insurance coverage within 30 days after the health care insurer receives the clean claim or within the time specified by the contract. If the claim is not a clean claim and the health care insurer requires additional information to adjudicate the claim, the health care insurer must send a written request for additional information to the contracted or noncontracted health care provider, enrollee or third party within 30 days after the health care insurer receives the claim.
A health care insurer must not delay the payment of clean claims to a contracted or noncontracted provider or pay less than the amount agreed to by contract to a contracted health care provider without reasonable justification (A.R.S. § 20-3102).
Provisions
1. Requires a health care insurer, if a claim or prior authorization is denied for any reason, to provide both:
a. a telephone number or email address to reach a department that can provide a detailed explanation and address questions as to why the claim or prior authorization was denied; and
b. a substantive response to questions about why the claim or prior authorization was denied within two business days after receipt of the questions. (Sec. 1, 2)
2. Contains an effective date of July 1, 2027. (Sec. 2)
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AG/LK HB 2194
1/27/2026 Page 0 Health & Human Services
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