NC S315

Requires insurers to complete utilization review determinations within 3 business days for non-urgent services and 24 hours for urgent services after receiving all necessary information

Prohibits insurers from using artificial intelligence algorithms as the sole basis for denying, delaying, or modifying healthcare services; only licensed qualified individuals may make medical necessity determinations

Mandates that appeals be reviewed by medical doctors with at least 3 consecutive years of practice in the same or similar specialty, who had no prior involvement in the case and no financial conflict of interest

Extends prior authorization validity to 90 days when a covered person enrolls in a new plan from the same insurer, and to at least 6 months for chronic condition treatments

Requires insurers to implement a prior authorization application programming interface meeting federal requirements by January 1, 2028, with most provisions taking effect October 1, 2026