Terms Used In Arizona Laws > Title 20 > Chapter 20 - Timely Payment of Claims

• Adjudicate: means an insurer's decision to deny or pay a claim, in whole or in part, including the decision as to how much to pay. See Arizona Laws 20-3101
• Amendment: A proposal to alter the text of a pending bill or other measure by striking out some of it, by inserting new language, or both. Before an amendment becomes part of the measure, thelegislature must agree to it.
• Appeal: A request made after a trial, asking another court (usually the court of appeals) to decide whether the trial was conducted properly. To make such a request is "to appeal" or "to take an appeal." One who appeals is called the appellant.
• 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
• Arbitration: means a dispute resolution process in which an impartial arbitrator determines the dollar amount a health care provider is entitled to receive for payment of a surprise out-of-network bill. See Arizona Laws 20-3111
• Arbitrator: means an impartial person who is appointed to conduct an arbitration. See Arizona Laws 20-3111
• Billing company: means any affiliated or unaffiliated company that is hired by a health care provider or health care facility to coordinate the payment of bills with health insurers and to generate or bill and collect payment from enrollees on the health care provider's or health care facility's behalf. See Arizona Laws 20-3111
• Clean claim: means a written or electronic claim for health care services or benefits that may be processed without obtaining additional information, including coordination of benefits information, from the health care provider, the enrollee or a third party, except in cases of fraud. See Arizona Laws 20-3101
• Complaint: A written statement by the plaintiff stating the wrongs allegedly committed by the defendant.
• Contract: A legal written agreement that becomes binding when signed.
• Contracted provider: means a health care provider that has entered into a contract with a health insurer to provide health care services to the health insurer's enrollees at agreed on rates. See Arizona Laws 20-3111
• 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
• Cost sharing requirements: means an enrollee's applicable out-of-network coinsurance, copayment and deductible requirements under a health plan based on the adjudicated claim. See Arizona Laws 20-3111
• 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
• Enrollee: means an individual who is enrolled under a health care insurer's policy, contract or evidence of coverage. See Arizona Laws 20-3101
• Enrollee: means an individual who is eligible to receive benefits through a health plan. See Arizona Laws 20-3111
• Evidence: Information presented in testimony or in documents that is used to persuade the fact finder (judge or jury) to decide the case for one side or the other.
• 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
• Fraud: Intentional deception resulting in injury to another.
• Grievance: means any written complaint that is subject to resolution through the insurer's system that is prescribed in section 20-3102, subsection F and submitted by a health care provider and received by a health care insurer. See Arizona Laws 20-3101
• Health care insurer: means a disability insurer, group disability insurer, blanket disability insurer, health care services organization, prepaid dental plan organization, hospital service corporation, medical service corporation, dental service corporation, optometric service corporation, or hospital, medical, dental and optometric service corporation. See Arizona Laws 20-3101
• Health care provider: means a person who is licensed, registered or certified as a health care professional under title 32 or a laboratory or durable medical equipment provider that furnishes services to a patient in a network facility and that separately bills the patient for the services. See Arizona Laws 20-3111
• Health care services: means treatment, services, medications, tests, equipment, devices, durable medical equipment, laboratory services or supplies rendered or provided to an enrollee for the purpose of diagnosing, preventing, alleviating, curing or healing human disease, illness or injury. See Arizona Laws 20-3111
• Health insurer: means a disability insurer, group disability insurer, blanket disability insurer, hospital service corporation or medical service corporation that provides health insurance in this state. See Arizona Laws 20-3111
• Health plan: means a group or individual health plan that finances or furnishes health care services and that is issued by a health insurer. See Arizona Laws 20-3111
• including: means not limited to and is not a term of exclusion. See Arizona Laws 1-215
• Lawsuit: A legal action started by a plaintiff against a defendant based on a complaint that the defendant failed to perform a legal duty, resulting in harm to the plaintiff.
• Network facility: means a health care facility that has entered into a contract with a health insurer to provide health care services to the health insurer's enrollees at agreed on rates. See Arizona Laws 20-3111
• Settlement: Parties to a lawsuit resolve their difference without having a trial. Settlements often involve the payment of compensation by one party in satisfaction of the other party's claims.
• Statute: A law passed by a legislature.
• Surprise out-of-network bill: means a bill for a health care service that was provided in a network facility by a health care provider that is not a contracted provider and that meets one of the requirements listed in section 20-3113. See Arizona Laws 20-3111
• Writing: includes printing. See Arizona Laws 1-215