Bill > HB1554

This bill requires insurance carriers to provide peer-to-peer review at any stage of prior authorization, establishing new standards for how these reviews are conducted. The bill mandates that when an insurance carrier issues an adverse prior authorization determination, the insured or their provider can request a peer-to-peer review at any time, even after an appeal has been initiated. The reviewing physician must meet specific qualifications, including holding an active medical license in the same or similar specialty as the treating provider, actively practicing in the same or similar field of medicine, and having expertise to assess the medical necessity of the specific procedure or service under review. Insurance carriers must now disclose the reviewer's full name, licensure type and state, and National Provider Identifier (NPI) to the requesting provider before or at the start of the peer-to-peer conversation. The carrier must schedule the peer-to-peer review within 5 business days of the request and provide a written determination within 7 business days of the review. Failure to comply with these requirements can be considered an unfair insurance practice subject to administrative penalties by the insurance commissioner. The bill is set to take effect on January 1, 2027, and aims to provide more transparency and flexibility in the prior authorization process for healthcare providers and patients.

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https://gc.nh.gov/bill_Status/billinfo.aspx?id=2027&inflect=2