Law / United States / 
Arizona
Denial of claims; individualized review requirement
In force since .
An AI sector rules rule binding private bodies.
- Audit expectation
- none
What it requires
- If you are a health care insurer, do not deny a claim submitted by a provider on the basis of medical necessity without a medical director individually reviewing the denial and exercising independent medical judgment.
- The reviewing medical director may not rely solely on recommendations from any other source, including an automated or AI-assisted recommendation, in making that individualized review.
These lines are LexLint's reading of the law's text.
In the frameworks
- NIST AI RMF
- MAP 3.5Processes for human oversight are defined, assessed, and documented in accordance with organizational policies from the GOVERN function.
Our reading of where this law's duties sit in each framework. It never says that running a control meets the law. How we read a framework against the law
What it makes you log
Logging duty
Section 20-3103 requires a medical director to individually review a medical-necessity denial and exercise independent medical judgment without relying solely on a recommendation from any other source; it states no duty to log, record, or document that the review took place, or what the review considered.
- Kind
- None
- As of
What this law does
Before a health care insurer may deny a claim submitted by a provider on the basis of medical necessity, a medical director must individually review the denial, exercise independent medical judgment, and may not rely solely on recommendations from any other source.
The section's own text and the Arizona Senate's fact sheet for the enacting bill, HB 2175 (2025), state this duty in technology-neutral terms; neither document uses the term artificial intelligence, though contemporaneous news coverage of the bill's passage describes it as a response to insurers' use of AI and algorithm-based tools to automate medical-necessity and prior-authorization denials.
Enacted in 2025 as Laws 2025, chapter 165 (HB 2175), approved by the Governor on , with the act itself providing that it is effective from and after .
When LexLint raises it
When your app profile says your app handles health records or is an insurer.
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