AZ| The Arizona Department of Insurance and Financial Institutions issued Regulatory Bulletin 2025-06 to clarify compliance requirements for health care insurers regarding direct denials of prior authorization requests on the basis of medical necessity, reflecting changes enacted by H.B. 2054 effective September 26, 2025.
Main Points:
- Arizona eliminated the requirement for the medical director who denies a prior authorization request to physically sign the written denial, but insurers must still maintain internal records identifying the responsible medical director.
- Written denials must continue to include specific explanations for denial and be sent to the requesting health care provider, with statutory licensing requirements for medical directors based on service type (medicine, dentistry, optometry, chiropractic care).
- Insurers failing to document the responsible medical director or their qualifications for medical necessity denials risk Department findings of statutory violation and potential administrative action.
