Arizona Laws 20-3458. Recredentialing
A. A health insurer or its designee may recredential participating providers at least once every thirty-six months and more frequently if required by federal or state law or the health insurer’s accreditation standards, or if permitted by the health insurer’s contract with the participating provider. Nothing in this section shall affect the contract termination rights of a health insurer or a participating provider.
Terms Used In Arizona Laws 20-3458
- Contract: A legal written agreement that becomes binding when signed.
- Designee: means a third party to whom the health insurer has delegated credentialing activities or responsibilities. 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
- Participating provider: means a provider that has been credentialed by a health insurer or its designee to provide health care items or services to subscribers in at least one of the health insurer's provider networks. See Arizona Laws 20-3451
- Provider: means a physician, hospital or other person that is licensed in this state or that is otherwise authorized to furnish health care services in this state. See Arizona Laws 20-3451
B. A participating provider remains credentialed and loaded in the health insurer’s billing system unless the health insurer discovers information that would result in the participating provider ceasing to meet the health insurer’s guidelines for participation, in which case the health insurer shall provide the participating provider a written explanation for the change in status.