Sections
Article 1 General Provisions 20-2501 – 20-2511
Article 2 Health Care Appeals 20-2530 – 20-2541

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
  • 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.
  • 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 20-101
  • Executor: A male person named in a will to carry out the decedent
  • 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
  • Lease: A contract transferring the use of property or occupancy of land, space, structures, or equipment in consideration of a payment (e.g., rent). Source: OCC
  • 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
  • Lien: A claim against real or personal property in satisfaction of a debt.
  • 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
  • Obligation: An order placed, contract awarded, service received, or similar transaction during a given period that will require payments during the same or a future period.
  • 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
  • Process: means a citation, writ or summons issued in the course of judicial proceedings. See Arizona Laws 1-215
  • 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
  • United States: includes the District of Columbia and the territories. See Arizona Laws 1-215
  • 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