A bill for an act relating to utilization review organizations’ use of artificial intelligence, prior authorization determinations and exemptions, and prepayment audits, and including applicability provisions.

This bill (SSB 3118) prohibits utilization review organizations (insurance companies that approve medical treatments) from using artificial intelligence as the sole basis to deny, delay, or downgrade prior authorization requests for medically necessary care. It requires human review by qualified medical professionals - either a "qualified reviewer" (a physician in the same specialty) or a "clinical peer" (a non-physician specialist) - for all denials or downgrades. The bill mandates written explanations for denials, including specific reasons and reviewer credentials, and requires a consultation between the provider and reviewer within seven business days of denial. It directly affects health insurers, healthcare providers requesting coverage, and patients needing treatment approvals.