Utah SB 319 — Health Insurance AI Disclosure in Prior Authorization: AI Compliance Requirements
Utah SB 319 was signed by the Governor on March 19, 2026. The law amends Utah's health insurance preauthorization statutes to require insurers to disclose when artificial intelligence or automated tools are used during prior authorization review. Applies to health insurance carriers, pharmacy benefit managers, and utilization review agents operating in Utah. The law also establishes timelines for prior authorization responses and strengthens protections against retroactive denial of previously approved care.
Key Facts
March 19, 2026
Utah Insurance Department enforcement; civil penalties under existing insurance law
What Your Business Must Do
3 compliance requirements identified. Critical requirements carry the highest risk of enforcement action.
Licensed Clinician Must Review AI-Assisted Denials
CriticalAI tools may be used to process and approve prior authorization requests, but any denial based on medical necessity must be reviewed and made by a licensed clinician working within their scope of practice — not by automated AI alone. Maintain documentation showing human clinician oversight of all denial decisions.
Disclose AI Use in Prior Authorization
High PriorityIf your organization uses artificial intelligence or automated tools as part of the prior authorization review process, you must disclose this to the requesting provider and patient. The disclosure must be included in prior authorization determination notices. Document which AI systems are used in prior auth workflows.
No Retroactive Denial of AI-Approved Care
High PriorityOnce prior authorization has been granted (including by AI-assisted processes) and care has been provided, the insurer generally cannot retroactively deny coverage or reduce payment below what was approved — unless specific exceptions apply (e.g., material misrepresentation by the provider). Implement controls to prevent retroactive AI-driven coverage modifications.
Frequently Asked Questions
Does Utah SB 319 — Health Insurance AI Disclosure in Prior Authorization apply to my business?
Utah SB 319 was signed by the Governor on March 19, 2026. The law amends Utah's health insurance preauthorization statutes to require insurers to disclose when artificial intelligence or automated tools are used during prior authorization review. App. Use ComplianceIQ's free scanner to get a personalized assessment in under 5 minutes.
What is the penalty for non-compliance?
The maximum penalty under Utah SB 319 — Health Insurance AI Disclosure in Prior Authorization is: Utah Insurance Department enforcement; civil penalties under existing insurance law. Fines are typically scaled by company size, severity of violation, and whether violations were willful or accidental.
How do I comply with Utah SB 319 — Health Insurance AI Disclosure in Prior Authorization?
The 3 requirements above cover the core obligations. The fastest path to compliance is: (1) conduct an AI risk assessment, (2) document your AI systems, (3) implement transparency disclosures where required. ComplianceIQ generates all required documents automatically.
Official Source
https://le.utah.gov/Session/2026/bills/static/SB0319.htmlLast updated: 2026-04-13 — verify at source before relying on this information.
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