Arizona Laws 20-2504. Utilization review agents; certification; rules
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A. The director shall issue a certificate to a utilization review agent that meets all of the requirements of this chapter and all applicable rules. A utilization review agent shall submit a signed and notarized application on a form prescribed by the director.
Terms Used In Arizona Laws 20-2504
- department: means the department of insurance and financial institutions. See Arizona Laws 20-101
- Utilization review: means a system for reviewing the appropriate and efficient allocation of inpatient hospital resources, inpatient medical services and outpatient surgery services that are being given or are proposed to be given to a patient, and of any medical, surgical and health care services or claims for services that may be covered by a health care insurer depending on determinable contingencies, including without limitation outpatient services, in-office consultations with medical specialists, specialized diagnostic testing, mental health services, emergency care and inpatient and outpatient hospital services. See Arizona Laws 20-2501
- Utilization review agent: means a person or entity that performs utilization review. See Arizona Laws 20-2501
B. A certificate is not transferable.
C. The director may adopt rules consistent with the requirements of this chapter.
D. Except as provided in section 20-2532, information required by the department with respect to customers, patients or utilization review plans is confidential and is not open to public inspection.
E. The utilization review agent shall pay all certification expenses as provided in section 20-2506.