SB1250 Summary

• Requires health care insurers to respond within 60 days to director inquiries about claims submitted up to three years after the date of service, when the administration has reasonable belief the individual was insured on the date of service.

• Prohibits health care insurers from denying claims submitted by the state solely based on lack of prior authorization if the administration authorized the item or service.

• Prohibits health care insurers from denying claims based on submission date, claim form type/format, or missing documentation at point of sale if submitted within three years and the state commences enforcement action within six years.

• Requires the director to publish an annual report by January 1 listing health care insurers not in material compliance with claims data reporting requirements and any corrective actions taken.

• Defines "health care insurer" to include self-insured plans, group health plans, pharmacy benefit managers, disability insurers, service corporations, and other entities responsible for paying for items or services provided to eligible persons under AHCCCS.