Title 20 — Insurance
29 chapters · 1,539 sections in this title.
A.R.S. § 20-3401 Definitions
4.2K chars
In this article, unless the context otherwise requires: 1. "Adverse determination": (a) Means a decision by a health care services plan or its utilization review agent that the health care services furnished or proposed to be furnished to an enrollee are not medically necessary a…
A.R.S. § 20-3402 Prior authorization; exceptions
0.6K chars
A. A health care services plan or its utilization review agent may impose a prior authorization requirement for health care services provided to an enrollee, except for emergency ambulance services and emergency services as specified in section 20-2803, health care services arisi…
A.R.S. § 20-3403 Prior authorization requirements; disclosures; access
1.9K chars
A. If a health care services plan contains a prior authorization requirement, all of the following apply: 1. The health care services plan or its utilization review agent shall make available to all providers on its website or provider portal a listing of all prior authorization …
A.R.S. § 20-3404 Prior authorization requirement timelines
2.7K chars
A. If a plan offered by a health care services plan contains a prior authorization requirement, all of the following apply: 1. For prior authorization requests concerning urgent health care services, the health care services plan or its utilization review agent shall notify the p…
A.R.S. § 20-3405 Prior authorization of prescription drugs for chronic pain conditions
1.9K chars
A. For a prior authorization request related to a chronic pain condition, the health care services plan or its utilization review agent shall honor a prior authorization that is granted for an approved prescription drug for the earliest of the following: 1. Six months after the d…
A.R.S. § 20-3406 Uniform prior authorization request forms; definition
1.5K chars
1. Not exceed two printed pages. This two-page limit does not apply to or include a provider's notes or documentation that the provider submits in support of a prior authorization request. 2. Meet the electronic submission and acceptance requirements prescribed in section 20-3403…
A.R.S. § 20-3407 Denial of prior authorization; review of prior authorization
0.4K chars
(Eff. 7/1/26) Before a health care insurer may issue a direct denial of a prior authorization of a service that was requested by a provider and that involves medical necessity, the medical director shall individually review the denial. During each individual review, the medical d…