HB 2599 – Arizona

Status: Enacted
Year Introduced: 2024
Link: https://apps.azleg.gov/BillStatus/BillOverview/80468

This bill addresses the processes of review and appeal for healthcare services within the state of Arizona and amends sections 20-2501, 20-2532, 20-2533, 20-2534, 20-2535, 20-2536 and 20-2537 of the Arizona Revised Statutes. It introduces changes to existing protocols and sets specific definitions related to medical review, reimbursements, and appeal procedures. The bill defines a series of terms relevant to healthcare service coverage, such as “adverse determination,” “claimed service,” “denial,” and “utilization review.” It also provides procedures for utilization reviews, which are systems for reviewing the allocation of medical resources for patients. Furthermore, the bill details the specific processes for appealing denied claims or services, including timelines and necessary documentation. It requires that healthcare insurers provide members with certain information regarding their right to appeal adverse decisions, including related procedures and timelines. Additionally, the bill outlines the roles of healthcare insurers and other entities responsible for performing reviews and dealing with appeals. It also mandates the maintenance of confidentiality for members’ medical records involved in reviews or appeals. Lastly, it sets guidelines for an expedited review process in cases where the regular timeline could lead to significant negative changes in a patient’s condition.

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