Article 1 Auditing 20-3321 – 20-3324

Terms Used In Arizona Laws > Title 20 > Chapter 25

  • Auditing entity: means any person, company, group or plan working on behalf of or pursuant to a contract with an insurer or pharmacy benefits manager for the purposes of auditing pharmacy drug claims adjudicated by pharmacies. See Arizona Laws 20-3321
  • Clerical errors: means a minor recordkeeping or transcribing error, including typographical errors, scrivner's errors or computer errors, in a required electronic or hard copy document, record or prescription order if both of the following criteria are met:

    (a) The error did not result in actual financial harm to an entity. See Arizona Laws 20-3321

  • Desktop audit: means an audit that is conducted by an auditing entity at a location other than the location of the pharmacist or pharmacy. See Arizona Laws 20-3321
  • In-pharmacy audit: means an audit that is conducted by an auditing entity at the physical business address of the pharmacy where the claim was adjudicated. See Arizona Laws 20-3321
  • Insurer: means a disability insurer, group disability insurer, blanket disability insurer, health care services organization, hospital service corporation, medical service corporation or hospital and medical service corporation. See Arizona Laws 20-3321
  • Pharmacy benefits manager: means a person, business or other entity that, pursuant to a contract or under an employment relationship with a carrier or other third-party payer, either directly or through an intermediary manages the prescription drug coverage provided by the carrier or other third-party payer, including the processing and payment of claims for prescription drugs, the performance of drug utilization review, the processing of drug prior authorization requests, the adjudication of appeals or grievances related to prescription drug coverage, contracting with network pharmacies and controlling the cost of covered prescription drugs. See Arizona Laws 20-3321