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 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)
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
HOUSE BILL 2175
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
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.
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.