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| 1 | + | REFERENCE TITLE: excessive health insurance claims; notification State of Arizona House of Representatives Fifty-seventh Legislature First Regular Session 2025 HB 2874 Introduced by Representative Liguori AN ACT amending title 20, chapter 2, article 1, Arizona Revised Statutes, by adding section 20-243; relating to the transaction of insurance business. (TEXT OF BILL BEGINS ON NEXT PAGE) | |
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| 9 | + | REFERENCE TITLE: excessive health insurance claims; notification | |
| 10 | 10 | State of Arizona House of Representatives Fifty-seventh Legislature First Regular Session 2025 | |
| 11 | - | HOUSE BILL 2874 | |
| 11 | + | HB 2874 | |
| 12 | + | Introduced by Representative Liguori | |
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| 13 | - | House Engrossed | |
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| 17 | - | excessive health insurance claims; notification | |
| 14 | + | REFERENCE TITLE: excessive health insurance claims; notification | |
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| 27 | 24 | State of Arizona | |
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| 29 | 26 | House of Representatives | |
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| 31 | 28 | Fifty-seventh Legislature | |
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| 33 | 30 | First Regular Session | |
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| 35 | 32 | 2025 | |
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| 43 | - | HOUSE BILL 2874 | |
| 40 | + | HB 2874 | |
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| 44 | + | Introduced by | |
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| 46 | + | Representative Liguori | |
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| 53 | 64 | AN ACT | |
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| 57 | - | amending title 20, chapter 2, article | |
| 68 | + | amending title 20, chapter 2, article 1, Arizona Revised Statutes, by adding section 20-243; relating to the transaction of insurance business. | |
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| 63 | 74 | (TEXT OF BILL BEGINS ON NEXT PAGE) | |
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| 67 | - | Be it enacted by the Legislature of the State of Arizona: Section 1. Title 20, chapter 2, article | |
| 78 | + | Be it enacted by the Legislature of the State of Arizona: Section 1. Title 20, chapter 2, article 1, Arizona Revised Statutes, is amended by adding section 20-243, to read: START_STATUTE20-243. Health care providers; excessive health care claims; notification; definitions A. If a health insurer notices a trend in the number of health care insurance claims that are filed by a health care provider for services provided to patients on any given workday exceeds the number of patients that the health care provider could reasonably be expected to treat on that given workday, the health insurer shall notify the department and the board that licenses, registers or certifies the health care provider. B. For the purposes of this section: 1. "Health care provider" means a person who is licensed, registered or certified as a health care professional under title 32. 2. "Health insurer" means a disability insurer, group disability insurer, blanket disability insurer, health care services organization, hospital service corporation or medical service corporation. END_STATUTE | |
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| 69 | 80 | Be it enacted by the Legislature of the State of Arizona: | |
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| 71 | - | Section 1. Title 20, chapter 2, article | |
| 82 | + | Section 1. Title 20, chapter 2, article 1, Arizona Revised Statutes, is amended by adding section 20-243, to read: | |
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| 73 | - | START_STATUTE20- | |
| 84 | + | START_STATUTE20-243. Health care providers; excessive health care claims; notification; definitions | |
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| 75 | 86 | A. If a health insurer notices a trend in the number of health care insurance claims that are filed by a health care provider for services provided to patients on any given workday exceeds the number of patients that the health care provider could reasonably be expected to treat on that given workday, the health insurer shall notify the department and the board that licenses, registers or certifies the health care provider. | |
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| 77 | - | B. If a property or casualty insurer notices claims activities that SUGGEST possible insurance or health care fraud, the property or casualty insurer shall notify the department and the applicable board that licenses, registers or certifies the health care provider. | |
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| 79 | - | C. For the purposes of this section: | |
| 88 | + | B. For the purposes of this section: | |
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| 81 | 90 | 1. "Health care provider" means a person who is licensed, registered or certified as a health care professional under title 32. | |
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| 83 | 92 | 2. "Health insurer" means a disability insurer, group disability insurer, blanket disability insurer, health care services organization, hospital service corporation or medical service corporation. END_STATUTE |