HB 2874
Initials JB Page 1 House Engrossed
ARIZONA HOUSE OF REPRESENTATIVES
Fifty-seventh Legislature
First Regular Session
House: APPROP DPA 17-0-0-1
HB 2874: excessive health insurance claims; notification
Sponsor: Representative Liguori, LD 5
House Engrossed
Overview
Directs a health care insurer to notify the Department of Insurance and Financial
Institutions (DIFI) and the applicable certification board if the insurer notices that the
number of health care insurance claims filed by the provider for patient services on any given
workday that exceeds the number of patients the provider could reasonably be expected to
treat on that given workday.
History
DIFI is a multifaceted agency that regulates the insurance industry, financial institutions
and enterprises. DIFI regulates such industries through licensure of financial and insurance
professionals such as collection agencies, mortgage bankers and brokers, insurers and
insurance producers, registering and certifying state-chartered banks and credit unions and
conducting scheduled examinations and investigating complaints of licensed professionals
and businesses (A.R.S. § 20-142).
Any person or other entity that provides coverage in this state for medical, surgical,
chiropractic, naturopathic medicine, occupational therapy, physical therapy, speech
pathology, audiology, professional mental health, dental, hospital or optometric expense,
whether the coverage is by direct payment, reimbursement or otherwise, is presumed to be
under the jurisdiction of DIFI unless the person or other entity shows that while providing
coverage it is under the jurisdiction of another agency of this state, this state itself or any
other state or the federal government (A.R.S. § 20-115).
Provisions
1. Requires a health care insurer that notices a trend in the number of health care insurance
claims filed by a provider for patient services on any given workday that exceeds the
number of patients the provider could reasonably be expected to treat on that given
workday to notify:
a) DIFI; and
b) the board that licenses, registers or certifies the provider. (Sec. 1)
2. Requires a property or casualty insurer that notices claim activities that suggest
possible insurance or health care fraud to notify DIFI and the applicable board that
licenses, registers or certifies the health care provider. (Sec. 1)
3. Defines health care provider as a person who is licensed, registered or certified as a health
care profession under state law. (Sec 1)
☐ Prop 105 (45 votes) ☐ Prop 108 (40 votes) ☐ Emergency (40 votes) ☐ Fiscal Note HB 2874
Initials JB Page 2 House Engrossed
4. Defines health care insurer as a disability insurer, group disability insurer, blanket
disability insurer, health care services organization, hospital service organization or
medical service corporation. (Sec. 1)