Arizona Laws 20-3453. Credentialing; loading; timelines; exception
A. Except as provided in subsection C of this section, the health insurer shall conclude the process of credentialing and loading the applicant‘s information into the health insurer’s billing system within one hundred calendar days after the date the health insurer receives a complete application.
Terms Used In Arizona Laws 20-3453
- Applicant: means a provider that submits a credentialing application to a health insurer to become a participating provider in the health insurer's network. See Arizona Laws 20-3451
- Application: means an applicant's initial application to be credentialed as a participating provider. See Arizona Laws 20-3451
- Credentialing: means to collect, verify and assess whether a provider meets relevant licensing, education and training requirements to become or remain a participating provider. See Arizona Laws 20-3451
- Health insurer: means a disability insurer, group disability insurer, blanket disability insurer, health care services organization, hospital service corporation, medical service corporation or a hospital, medical, dental and optometric service corporation and includes the health insurer's designee. See Arizona Laws 20-3451
- Loading: means to input a participating provider's information into a health insurer's billing system for the purpose of processing claims and submitting reimbursement for covered services. See Arizona Laws 20-3451
- Process: means a citation, writ or summons issued in the course of judicial proceedings. See Arizona Laws 1-215
B. A health insurer shall provide written or electronic notice of the approval or denial of a credentialing application to an applicant within seven calendar days after the conclusion of the credentialing process.
C. If a licensed health care facility has a delegated credentialing agreement with a health insurer, the health insurer is not responsible for compliance with the timeline prescribed in subsection A of this section for an applicant who works for that facility, but shall conclude the loading process for that applicant within ten calendar days after the health insurer receives a roster of demographic changes related to newly credentialed, terminated or suspended participating providers.