AR HB1274

Expands the definition of "utilization review entity" to include third-party administrators of self-insured healthcare insurers that perform prior authorizations.

Establishes a 4 business day appeal process for denials of nonurgent healthcare services, during which the utilization review entity must make an authorization or adverse determination and notify the subscriber and healthcare provider.

Establishes a 2 business day appeal process for denials of urgent healthcare services, during which the utilization review entity must make an authorization or adverse determination and notify the subscriber and healthcare provider.

Applies expedited appeal timelines only to enrollees being evaluated or treated for hematology diagnosis, oncology diagnosis, or additional disease states designated by the Insurance Commissioner through rule.

Requires utilization review entities to automatically authorize preferred treatments under step therapy requirements without requiring healthcare providers to submit new or revised requests when prior authorization is required.