Title 20 — Insurance
29 chapters · 1,539 sections in this title.
A.R.S. § 20-3451 Definitions
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In this chapter, unless the context otherwise requires: 1. "Applicant" means a provider that submits a credentialing application to a health insurer to become a participating provider in the health insurer's network. 2. "Application" means an applicant's initial application to be…
A.R.S. § 20-3452 Requirements for electronic application submission
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A. A health insurer shall establish a process for the electronic submission of a credentialing application. On or before December 31, 2019, the health insurers shall adopt and implement a standard application. B. On or before December 31, 2019, to the greatest extent possible, a …
A.R.S. § 20-3453 Credentialing; loading; timelines; exception
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A. Except as provided in subsection C of this section, the health insurer shall conclude the process of credentialing within sixty calendar days and loading the applicant's information into the health insurer's billing system within thirty calendar days after the date the health …
A.R.S. § 20-3454 Acknowledgement of receipt of an application; notification of incomplete applications
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A. When submitting a credentialing application, a health insurer shall provide written or electronic acknowledgement to an applicant within seven calendar days after the health insurer's receipt of the application. The applicant shall include in the application a contact name, te…
A.R.S. § 20-3455 Reported discrepancies; corrective action
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A health insurer shall take reasonable steps to correct discrepancies in the provider or network plan directory within thirty calendar days after receiving a written or electronic report of the discrepancy from a participating provider. A participating provider shall notify a hea…
A.R.S. § 20-3456 Covered services; claims; payment; disclosure
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A. A provider may receive payment from a health insurer pursuant to this section for services that were provided from the date that was included on the notice of complete credentialing application to the date the provider's network participation contract is executed. A health ins…
A.R.S. § 20-3457 Availability of credentialing information; policies
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1. The applicable credentialing policies and procedures. 2. A list of all the information required to be included in an application. 3. A checklist of materials that must be submitted in the credentialing process. 4. Designated contact information, including a designated point of…
A.R.S. § 20-3458 Recredentialing
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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 …
A.R.S. § 20-3459 Civil immunity; enforcement; civil penalty
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A. A health insurer that complies in good faith with the requirements of this chapter is immune from civil liability for the purposes of reviewing and approving a credentialing application. B. A health insurer that does not credential a provider is not subject to civil liability …