House Engrossed claims; prior authorization; conduct State of Arizona House of Representatives Fifty-seventh Legislature First Regular Session 2025 HOUSE BILL 2175 AN ACT amending title 20, chapter 20, article 1, arizona revised statutes, by adding section 20-3103; relating to health care insurance claims. (TEXT OF BILL BEGINS ON NEXT PAGE)
House Engrossed claims; prior authorization; conduct
State of Arizona House of Representatives Fifty-seventh Legislature First Regular Session 2025
HOUSE BILL 2175
House Engrossed
claims; prior authorization; conduct
State of Arizona
House of Representatives
Fifty-seventh Legislature
First Regular Session
2025
HOUSE BILL 2175
AN ACT
amending title 20, chapter 20, article 1, arizona revised statutes, by adding section 20-3103; relating to 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. artificial intelligence may not be used to deny a claim or a prior authorization for medical necessity, experimental status or any other reason that involves the use of medical judgment. B. a health care provider shall individually review each claim or prior authorization that involves medical necessity, experimental status or that requires the use of medical judgment before a health care insurer may deny a claim or a prior authorization. C. 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. D. 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 or who holds a similar license in another state. END_STATUTE
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. artificial intelligence may not be used to deny a claim or a prior authorization for medical necessity, experimental status or any other reason that involves the use of medical judgment.
B. a health care provider shall individually review each claim or prior authorization that involves medical necessity, experimental status or that requires the use of medical judgment before a health care insurer may deny a claim or a prior authorization.
C. 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.
D. 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 or who holds a similar license in another state. END_STATUTE