Arizona 2025 2025 Regular Session

Arizona House Bill HB2130 Comm Sub / Analysis

Filed 01/30/2025

                      	HB 2130 
Initials AG/AB 	Page 1 	Health & Human Services 
☐ Prop 105 (45 votes)     ☐ Prop 108 (40 votes)      ☐ Emergency (40 votes) ☐ Fiscal Note 
 
ARIZONA HOUSE OF REPRESENTATIVES 
Fifty-seventh Legislature 
First Regular Session 
 
 
HB 2130: claims; prior authorization; denials; contact 
Sponsor: Representative Bliss, LD 1 
Committee on Health & Human Services 
Overview 
Requires a health care insurer that denies a claim or prior authorization for any reason to 
provide both a detailed explanation as to why a claim or prior authorization was denied and 
the contact information of the individual or specific department that can address questions 
about the claim or prior authorization denial. 
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 detailed explanation as to why the claim or prior authorization was denied; and 
b) the name and contact information of an individual or specific department of the 
insurer that can address questions about the claim or prior authorization denial.    
(Sec. 1)