AZ HB2407

Prohibits health insurers from using automated processes, systems, or tools to make final decisions to downcode insurance claims, requiring instead a documented review by a licensed health care professional of the same specialty as the treating provider.

Requires insurers who downcode claims to provide specific notification including the reason for downcoding, original and revised service codes and payment amounts, the reviewing professional's credentials, and notice of appeal rights.

Establishes a mandatory appeals process with at least 180 days to submit an appeal, and allows health care providers to appeal similar downcoding issues in batches without restriction.

Prohibits discriminatory downcoding practices against providers who routinely treat patients with complex or chronic conditions, with potential enforcement actions including fines, restitution, or license suspension.

Authorizes the Department of Insurance to enforce violations through civil penalties of up to $100 per violation and orders to reprocess improperly downcoded claims with interest.