Denial of claims; individualized review requirement

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What follows is LexLint's own research summary of this law, not legal advice.

In force 84 days, effective 1 July 2026.

An AI sector rules rule binding private bodies.

As of 6 September 2026.

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.

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: 21 September 2026

Who checks it

Audit expectation

none

What this law does

Drafted with AI from the cited sources under the direction of UnGovr staff. UnGovr holds editorial responsibility for this page.

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 HB 2175, with the codified section itself noting an effective date of July 1, 2026.

When LexLint raises it

high_risk_decisions
handles_health_records
provides_financial_services

Read the law

official Arizona Revised Statutes text, Arizona State Legislature website

Every line above is drawn from the primary source linked here, read on the date shown. This is a research summary, not legal advice.

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