GA HB1236

Requires a clinical peer licensed in Georgia to agree to any adverse determination when a private review agent or utilization review entity questions the medical necessity of a healthcare service.

Mandates that the clinical peer reviewing medical necessity cases must be trained in a related specialty and licensed in Georgia.

Requires review entities to attempt to discuss the patient's care with the treating healthcare provider or qualified designee during normal working hours before making an adverse determination.

Changes notice requirements so that adverse determinations "must" (rather than "will") specify the reasons for the review determination to the treating healthcare provider.

Effective January 1, 2027, applying to all insurance policies or contracts issued, delivered, or renewed on or after that date.