DE SB12

Requires insurers to respond to pre-authorization requests within shorter timeframes: 3 business days for electronic submissions, 5 business days for non-electronic submissions, 24 hours for urgent services and patient transfers submitted electronically, and 48 hours for urgent services submitted non-electronically

Mandates that adverse pre-authorization determinations and appeals be reviewed by physicians licensed in the same or similar specialty as the requesting provider, with compensation not contingent on the outcome

Extends pre-authorization validity from 60 days to 90 days and limits insurers to requiring only one pre-authorization per episode of care for a specific medical condition

Requires insurers to establish electronic provider portals by January 1, 2027 for submitting pre-authorization requests, accessing medical policies, and requesting peer-to-peer reviews

Mandates 6 months advance notice to covered persons before changes to utilization review criteria take effect, and requires insurers to report pre-authorization approval, denial, and appeal statistics to the Delaware Health Information Network at least twice annually