If the director believes that a utilization review agent is violating or is about to violate section 20-2502, the director may order the agent to cease and desist. The director through the attorney general may file a complaint in the superior court in the county in which the agent transacts utilization review business to enjoin and restrain the agent from committing or continuing the violation. If the director orders the utilization review agent to cease and desist, the agent may request a hearing pursuant to Title 41, Chapter 6, Article 10 and, except as provided in Section 41-1092.08, subsection H, seek judicial review pursuant to Title 12, Chapter 7, Article 6. If the director files a complaint through the attorney general the superior court has jurisdiction of the proceeding and may make and enter an order or judgment awarding preliminary or final relief as in its judgment is proper.

Terms Used In Arizona Laws 20-2511

  • Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
  • Jurisdiction: (1) The legal authority of a court to hear and decide a case. Concurrent jurisdiction exists when two courts have simultaneous responsibility for the same case. (2) The geographic area over which the court has authority to decide cases.
  • 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

 

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