HB 2175: claims; prior authorization; conduct - Arizona

Senate Engrossed Version → Chaptered Version · 3 edits

MINOR

The document was converted from a pending Senate version of a bill into an officially enacted law (Chapter 165). The primary change is the addition of the Governor's approval date and the Secretary of State's filing date, confirming the bill is now active law. The effective date of June 30, 2026, remains unchanged.

TIMELINE

Added the official approval date (May 12, 2025) and filing date, indicating the bill has become law.

TECHNICAL

Changed the document title from 'HB2175 - 571R - S Ver' to 'Chapter 0165 - 571R - S Ver of HB2175' to reflect its official chapter status.

Removed the 'HOUSE BILL 2175' header and blank lines associated with the draft bill format.

House Engrossed Version → Senate Engrossed Version · 5 edits · Apr 29, 2025

MODERATE

The bill was amended to shift focus from requiring health care providers to review claims to requiring health care insurers to review denials. The original version mandated that providers individually review claims before insurers could deny them, while the new version requires insurers' medical directors to individually review denials before they are issued. This changes the responsibility for ensuring proper review from the provider to the insurer.

Scope change

The bill now adds a new section (20-3407) in Title 20, Chapter 26 regarding insurance, in addition to the existing section (20-3103) in Title 20, Chapter 20 regarding health care providers.

REQUIREMENT

Changed the review requirement from health care providers reviewing claims before denial to health care insurers' medical directors reviewing denials before they are issued.

Added new section 20-3407 requiring medical directors to exercise independent medical judgment when reviewing prior authorization denials.

Removed the requirement that health care providers must individually review claims before insurers can deny them.

ENFORCEMENT

Removed the provision that treating a claim denial without individual review as unprofessional conduct for health care providers.

TIMELINE

Added Section 3 establishing that the act becomes effective on or after June 30, 2026.

Introduced Version → House Engrossed Version · 3 edits · Apr 29, 2025

MINOR

The bill was reformatted and slightly modified to clarify the scope of AI restrictions in healthcare claim denials. The House version adds specific exceptions for AI use, limiting it only for claims involving medical necessity, experimental status, or medical judgment, while the introduced version had a broader prohibition. The definition of 'health care provider' was also updated to include those holding similar licenses in other states.

Scope change

The bill's scope was narrowed by specifying that AI restrictions apply only to claims involving medical necessity, experimental status, or medical judgment, rather than all claim denials.

REQUIREMENT

Added specific exceptions to the AI prohibition, allowing AI use for claims not involving medical necessity, experimental status, or medical judgment.

DEFINITION

Expanded the definition of 'health care provider' to include individuals holding similar licenses in other states.

TECHNICAL

Formatting and structural changes including header updates, page numbering, and section numbering adjustments.

claims; prior authorization; conduct

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