Terms Used In Arizona Laws > Title 20 > Chapter 15 - Utilization Review

• Adverse decision: means a utilization review determination by the utilization review agent that a requested service or claim for service is not a covered service or is not medically necessary under the plan if that determination results in a documented denial or nonpayment of the service or claim. See Arizona Laws 20-2501
• Application: means an application which is made pursuant to this article for approval of the deputy director to become a financial institution holding company. See Arizona Laws 6-1101
• Bank: means a corporation that holds a banking permit issued pursuant to chapter 2 of this title. See Arizona Laws 6-101
• Benefits based on the health status of the insured: means a contract of insurance to pay a fixed benefit amount, without regard to the specific services received, to a policyholder who meets certain eligibility criteria based on health status including:

  (a) A disability income insurance policy that pays a fixed daily, weekly or monthly benefit amount to an insured who is deemed to have a disability as defined by the policy terms. See Arizona Laws 20-2501

• Claim: means a request for payment for a service already provided. See Arizona Laws 20-2501
• Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
• Control: means direct or indirect ownership or power to vote twenty-five percent or more of the outstanding voting securities of a financial institution or controlling person or to control in any manner the election of a majority of the directors of a financial institution or controlling person. See Arizona Laws 6-1101
• Controlling person: means a person who is directly or indirectly in control of a financial institution. See Arizona Laws 6-1101
• Covered service: means a service that is included in a policy, evidence of coverage or similar document that specifies which services, insurance or other benefits are included or covered. See Arizona Laws 20-2501
• Denial: means a direct or indirect determination regarding all or part of a request for any service or a direct determination regarding a claim that may trigger a request for review or reconsideration. See Arizona Laws 20-2501
• Department: means the department of insurance and financial institutions. See Arizona Laws 6-101
• department: means the department of insurance and financial institutions. See Arizona Laws 20-101
• Deputy director: means the deputy director of the financial institutions division of the department. See Arizona Laws 6-101
• Financial institution: means a bank, trust company, savings and loan association, international banking facility and holding company of a bank, trust company, savings and loan association and international banking facility under the jurisdiction of the department. See Arizona Laws 6-1101
• Financial institution holding company: means a corporation, trust, association, partnership or similar organization that directly or indirectly, acting through one or more persons, controls a financial institution or a controlling person. See Arizona Laws 6-1101
• Health care insurer: means a disability insurer, group disability insurer, blanket disability insurer, health care services organization, hospital service corporation, prepaid dental plan organization, medical service corporation, dental service corporation or optometric service corporation or a hospital, medical, dental and optometric service corporation. See Arizona Laws 20-2501
• International banking facility: means a facility that is represented by a set of asset and liability accounts segregated on the books and records of a commercial bank, the principal office of which is located in this state, and that is incorporated and doing business under the laws of the United States or of this state, a United States branch or agency of a foreign bank, an edge corporation organized under section 25(a) of the federal reserve act (12 United States Code §§ 611 through 631) or an agreement corporation having an agreement or undertaking with the board of governors of the federal reserve system under section 25 of the federal reserve act (12 United States Code §§ 601 through 604(a)) that includes only international banking facility time deposits and international banking facility extensions of credit as defined in Title 12 of the Code of Federal Regulations, Part 204. See Arizona Laws 6-101
• Lessee: means a person contracting with a lessor for the use of a safe deposit repository. See Arizona Laws 6-1001
• Lessor: means a corporation or association authorized under the laws of this state, any other state or the United States to do business as a bank, trust company, credit union or savings and loan association and maintaining safe deposit repositories for public use. See Arizona Laws 6-1001
• Moral turpitude: means an offense, whether a misdemeanor or felony, that is related to extortion, burglary, larceny, bribery, embezzlement, robbery, racketeering, money laundering, forgery, fraud, murder, voluntary manslaughter or a sexual offense that requires the individual to register pursuant to section 13-3821. See Arizona Laws 1-215
• Partnership: A voluntary contract between two or more persons to pool some or all of their assets into a business, with the agreement that there will be a proportional sharing of profits and losses.
• Power of attorney: A written instrument which authorizes one person to act as another's agent or attorney. The power of attorney may be for a definite, specific act, or it may be general in nature. The terms of the written power of attorney may specify when it will expire. If not, the power of attorney usually expires when the person granting it dies. ^{Source: OCC}
• Provider: means the physician or other licensed practitioner identified to the utilization review agent as having primary responsibility for providing care, treatment and services rendered to a patient. See Arizona Laws 20-2501
• Registered mail: includes certified mail. See Arizona Laws 1-215
• repository: means a safe deposit box or any other safe deposit receptacle and includes the lessor's vault space made available for use by the lessee in common with others for the storage of property or documents. See Arizona Laws 6-1001
• 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
• Service: means a diagnostic or therapeutic medical or health care service, benefit or treatment. See Arizona Laws 20-2501
• Utilization review: means a system for reviewing the appropriate and efficient allocation of inpatient hospital resources, inpatient medical services and outpatient surgery services that are being given or are proposed to be given to a patient, and of any medical, surgical and health care services or claims for services that may be covered by a health care insurer depending on determinable contingencies, including without limitation outpatient services, in-office consultations with medical specialists, specialized diagnostic testing, mental health services, emergency care and inpatient and outpatient hospital services. See Arizona Laws 20-2501
• Utilization review agent: means a person or entity that performs utilization review. See Arizona Laws 20-2501
• Utilization review plan: means a summary description of the utilization review guidelines, protocols, procedures and written standards and criteria of a utilization review agent. See Arizona Laws 20-2501