A. For plan years beginning on or after January 1, 2027, a health benefit plan must implement and maintain a Prior Authorization Application Programming Interface (API), as described in 45 C.F.R. Part 156. B. By July 1, 2027, health care providers must have electronic health records or practice management systems that are compatible with the API. C. As of the effective date of this act, a utilization review entity must provide health care providers with the following opportunities for communication during the prior authorization process:
1. Make staff available at least eight (8) hours a day during normal business hours for inbound telephone calls regarding prior authorization issues;
2. Allow staff to receive inbound communication regarding prior authorization issues after normal business hours; and 3. Provide a treating provider with the opportunity to discuss a prior authorization denial with an appropriate reviewer.