claims; prior authorization; denials; contact

Plain English Breakdown

The effective date in the official summary and text differs from the candidate explanation.

Health Care Insurer Contact Requirements for Claim Denials

This bill requires health care insurers to provide contact information and a detailed explanation within two business days if they deny a claim or prior authorization.

What This Bill Does

• Requires health care insurers to give the contact details of a department that can explain why a claim was denied.
• Requires health care insurers to respond with more details about why a claim was denied within two business days after receiving questions.
• Applies similar requirements for prior authorizations when they are denied by health care insurers.

Who It Names or Affects

• Health care insurers who deny claims or prior authorizations
• People and providers affected by claim denials

Terms To Know

Prior Authorization

A process where a health insurance company must approve certain medical treatments before they are given.

Health Care Insurer

An organization that provides or pays for health care services and benefits under an insurance policy.

Limits and Unknowns

• The bill does not specify what happens if the insurer fails to provide the required information.
• It is unclear how this will affect insurers' current practices regarding claim denials.

Official Summary Text

HB2194 - 572R - House Bill Summary

ARIZONA HOUSE OF REPRESENTATIVES

57th
Legislature, 2nd Regular Session

Majority Research Staff

House:
HHS DP 12-0-0-0

HB
2194
: claims; prior authorization; denials; contact

Sponsor:
Representative Bliss, LD 1

Caucus
& COW

Overview

Effective
July 1, 2027, requires a health care insurer that denies a claim or prior
authorization for any reason to provide the contact information of a department
that can provide a detailed explanation and a substantive response to questions
about why the claim or prior authorization was denied.

History

Health care
insurer
means a
disability insurer, group disability insurer, blanket disability insurer,
health care services organization, prepaid dental plan organization, hospital
service corporation, medical service corporation, dental service corporation,
optometric service corporation or hospital, medical, dental and optometric
service corporation.
Clean claims
are written or electronic claims for
health care services or benefits that may be processed without obtaining
additional information, including coordination of benefits information, from
the health care provider, the enrollee or a third party, except in fraud cases
(
A.R.S. � 20-3101
).

Statute outlines
the process for timely payment of health care provider's claims and to address
grievances. Specifically, health care insurers must adjudicate any clean claim
from a contracted or noncontracted health care provider relating to health care
insurance coverage within 30 days after the health care insurer receives the
clean claim or within the time specified by the contract. If the claim is not a
clean claim and the health care insurer requires additional information to
adjudicate the claim, the health care insurer must send a written request for
additional information to the contracted or noncontracted health care provider,
enrollee or third party within 30 days after the health care insurer receives
the claim.

A health care
insurer must not delay the payment of clean claims to a contracted or
noncontracted provider or pay less than the amount agreed to by contract to a
contracted health care provider without reasonable justification (
A.R.S.
� 20-3102
).

Provisions

1.

Requires a health care insurer,
if a claim or prior authorization is denied for any reason, to provide both:

a.

a telephone number or email
address to reach a department that can provide a detailed explanation and
address questions as to why the claim or prior authorization was denied; and

b.

a substantive response to
questions about why the claim or prior authorization was denied within two
business days after receipt of the questions. (Sec. 1, 2)

2.

Contains an effective date of
July 1, 2027. (Sec. 2)

3.

4.

5.

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FOOTER ---------

6.

Initials AG/LK��������������� HB
2194

7.

2/2/2026��� Page 0 Caucus
& COW

8.

9.

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FOOTER ---------

Current Bill Text

HB2194 - 572R - I Ver

PREFILED��� JAN 09 2026

REFERENCE TITLE:
claims; prior authorization; denials; contact

State of Arizona

House of Representatives

Fifty-seventh Legislature

Second Regular Session

2026

HB 2194

Introduced by

Representative
Bliss

AN
ACT

amending title 20, chapter 20, article 1,
arizona revised statutes, by adding sections 20-3104 and 20-3105;
relating to timely payment of health care insurance claims.

(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
sections 20-3104 and 20-3105, to read:

START_STATUTE
20-3104.

Health care insurer; claim denials; contact person

If a health care insurer denies a claim for any
reason, the health care insurer shall provide both of the following:

1.
A telephone
number or email address to reach a department that can provide a detailed
explanation
and address questions as to why the claim was
denied.

2. A substantive response to
questions about why the claim was denied within two business days after RECEIPT
of the questions.
END_STATUTE

START_STATUTE
20-3105.

Health care insurer; prior authorization denials; contact person

If a health care insurer denies a prior
authorization for any reason, the health care insurer shall provide both of the
following:

1. A telephone number or email
address to reach a department that can provide a detailed explanation and
address questions as to why the prior authorization was denied.

2. A substantive response to
questions about why the prior authorization was denied within two business days
after receipt of the questions.
END_STATUTE

Sec. 2.
Effective date

Sections 20-3104 and 20-3105,
Arizona Revised Statutes, as added by this act, are effective from and after
June 30, 2027.