§ 20-3451 Definitions
§ 20-3452 Requirements for electronic application submission
§ 20-3453 Credentialing; loading; timelines; exception
§ 20-3454 Acknowledgement of receipt of an application; notification of incomplete applications
§ 20-3455 Reported discrepancies; corrective action
§ 20-3456 Covered services; claims
§ 20-3457 Availability of credentialing information; policies
§ 20-3458 Recredentialing
§ 20-3459 Civil immunity; enforcement; civil penalty

Terms Used In Arizona Laws > Title 20 > Chapter 27 > Article 1 - General Provisions

  • 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
  • Contract: A legal written agreement that becomes binding when signed.
  • Corporation: A legal entity owned by the holders of shares of stock that have been issued, and that can own, receive, and transfer property, and carry on business in its own name.
  • 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
  • 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
  • including: means not limited to and is not a term of exclusion. See Arizona Laws 1-215
  • 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
  • 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
  • Person: includes a corporation, company, partnership, firm, association or society, as well as a natural person. See Arizona Laws 1-215
  • Process: means a citation, writ or summons issued in the course of judicial proceedings. See Arizona Laws 1-215
  • 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
  • sent: means to deliver by United States mail, personal delivery or fax or by electronic means consistent with the requirements of section 20-239. See Arizona Laws 20-117
  • Subscriber: means a person who is eligible to receive health care benefits pursuant to a health insurance policy or coverage issued or provided by a health insurer. See Arizona Laws 20-3451
  • Writing: includes printing. See Arizona Laws 1-215