Binding law — in force
The medical director individually reviews every medical-necessity denial of a claim or prior authorization (Arizona HB 2175)
From 2026-07-01, before a health care insurer denies a claim a provider submitted on the basis of medical necessity (A.R.S. 20-3103), or issues a direct denial of a provider's prior-authorization request that involves medical necessity (20-3407), the medical director must individually review the denial, exercising independent medical judgment and not relying solely on recommendations from any other source. The act never mentions AI: it binds whatever tool proposes the denial, and AI and algorithmic claim-review and prior-authorization tools are where it bites. Detect model or scoring output that sets a denial with no medical-director or clinical review step.
az-hb2175.medical-director-reviews-every-denial · A.R.S. 20-3103 (Laws 2025, ch. 165, sec. 1) · official source · jurisdictions: US-AZ