reglab/statecodes huggingface dataset:
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3209 - Immunity from liability

20-3209.
Immunity from liability
A. The director,  the director's authorized representatives or any examiner appointed by the director is not liable for any statements made or conduct performed in good faith while carrying out the provisions of this chapter.
B. A person who communicates or delivers information or data to the director,  the director's authorized representative or an examiner pursuant to an examination made under this chapter is not liable for the communication or delivery if the communication or delivery was performed in good faith and without fraudulent intent or the intent to deceive.
C. A person listed in subsection A or B is entitled to attorney fees and costs if the person is the prevailing party in a civil cause of action for libel,  slander or other relevant tort arising out of activities in carrying out the provisions of this chapter and the party bringing the action was not substantially justified in doing so. For the purposes of this subsection,  a proceeding is substantially justified if it had a reasonable basis in law or fact at the time that it was initiated.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3210 - Annual statements; record retention

20-3210.
Annual statements;  record retention
A. Each licensed provider shall file with the director on or before March 1 of each year an annual statement in a form prescribed by the director. The annual statement shall be verified by the oath of at least two of its principal officers,  showing its condition at the end of the preceding calendar year. In addition to any other requirements,  the annual statement shall include the total number,  aggregate face amount and life settlement proceeds of policies settled during the immediately preceding calendar year,  together with a breakdown of the information by policy issue year. The annual statement shall not include individual transaction data regarding the business of life settlements or information that there is a reasonable basis to believe could be used to identify the owner or the insured.
B. The provider shall maintain records of all consummated transactions and life settlement contracts for three years after the death of the insured. The director may inspect these records during reasonable business hours.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3212 - Scope of chapter

20-3212.
Scope of chapter
This chapter does not:
1. Preempt the authority or relieve the duty of other law enforcement or regulatory agencies to investigate,  examine and prosecute suspected violations of law.
2. Prevent or prohibit a person from disclosing voluntarily information concerning life settlement fraud to a law enforcement or regulatory agency other than the department.
3. Limit the powers granted elsewhere by the laws of this state to the director or an insurance fraud unit to investigate and examine possible violations of law and to take appropriate action against wrongdoers.
4. Preempt or otherwise limit title 44,  chapter 12 or any rules,  orders,  policy statements,  notices,  bulletins or other interpretations issued by or through the corporation commission or the corporation commission's designee acting pursuant to title 44,  chapter 12. Compliance with this chapter does not constitute compliance with any applicable provision of title 44,  chapter 12 or any rules,  orders,  policy statements,  notices,  bulletins or other interpretations issued by or through the corporation commission or the corporation commission's designee acting pursuant to title 44,  chapter 12.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3213 - Applicability

20-3213.
Applicability
A. A provider lawfully transacting business in this state before the effective date of this chapter may continue to transact business in this state,  pending approval or disapproval of that person's application for a license,  if the provider files the application with the director not later than thirty days after publication by the director of an application form and instructions for licensure of providers. If the publication of the application form and instructions occurs before the effective date of this chapter,  the provider shall file the application not later than thirty days after the effective date of this chapter. During the time that an application is pending with the director,  the applicant may use any form of life settlement contract that has been filed with the director pending approval of the application if the form is otherwise in compliance with this chapter.
B. A person who has lawfully acted as a broker and negotiated life settlement contracts between any owner residing in this state and one or more providers for at least one year immediately before the effective date of this chapter may continue to do so pending approval or disapproval of that person's application for a license if the broker files the application with the director not later than thirty days after publication by the director of an application form and instructions for licensure of brokers. If the publication of the application form and instructions occurs before the effective date of this chapter,  the broker shall file the application not later than thirty days after the effective date of this chapter.
C. Any person transacting business in this state under this section shall comply with all requirements of this chapter.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3214 - Injunctions; civil remedies; cease and desist

20-3214.
Injunctions;  civil remedies;  cease and desist
A. In addition to the penalties and other enforcement provisions of this chapter,  if any person violates any provision of this chapter or any rule adopted pursuant to this chapter,  the director may seek an injunction in a court of competent jurisdiction in the county where the person resides or has a principal place of business and may apply for temporary and permanent orders that the director determines are necessary to restrain the person from further committing the violation.
B. Any person who is damaged by the acts of another person in violation of this chapter or any rule adopted pursuant to this chapter may bring a civil action for damages against the person committing the violation in a court of competent jurisdiction.
C. The director may issue a cease and desist order pursuant to section 20-456 upon a person who violates any provision of this chapter,  any rule or order adopted by the director or any written agreement entered into with the director.
D. If the director finds that an action presents an immediate danger to the public and requires an immediate final order,  the director may issue an emergency cease and desist order reciting with particularity the facts underlying the findings. The emergency cease and desist order is effective immediately upon service of a copy of the order on the respondent and remains effective for ninety days. If the department begins nonemergency cease and desist proceedings under subsection C of this section,  the emergency cease and desist order remains effective,  absent an order by a court of competent jurisdiction. In addition to actual damages,  if the violation of this chapter was willful,  the trial court may award statutory damages in an amount up to three times the actual damages awarded. The provisions of this chapter may not be waived by agreement. No choice of law provision may be used to prevent the application of this chapter to any settlement in which a party to the settlement is a resident of this state.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3215 - Penalties

20-3215.
Penalties
A. It is a violation of this chapter for any person,  provider,  broker or party related to the business of life settlements to commit a fraudulent life settlement act.
B. A person who commits a fraudulent life settlement act is guilty of committing insurance fraud and is subject to section 20-466.01.
C. The director may seek an injunction and an order of restitution and may levy a civil penalty pursuant to section 20-466.02 on any person who is licensed pursuant to this chapter and who is found to have committed a fraudulent life settlement act or to have violated any other provision of this chapter.
D. The director may deny,  suspend for not more than twelve months,  revoke or refuse to renew the license of a person who commits a fraudulent life settlement act.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3301 - Definitions; applicability

20-3301.
Definitions;  applicability
A. In this article,  unless the context otherwise requires:
1. " Insurance compliance audit"  means a voluntary,  internal evaluation,  review,  assessment,  audit or investigation that follows adopted written standards and criteria for the purpose of identifying or preventing noncompliance with or promoting compliance with laws,  regulations,  orders or industry or professional standards that is conducted by or on behalf of a company licensed or regulated under this title and specified in subsection B of this section,  or that involves an activity regulated under this title. An audit shall establish a start and end date.
2. " Insurance compliance audit document" :
(a) Means documents prepared as a result of or in connection with an insurance compliance audit and identified specifically as part of an insurance compliance audit.
(b) Includes any of the following:
(i) An insurance compliance audit report prepared by an auditor,  who may be an employee of the company or an independent contractor,  which may include the scope of the audit,  the information gained in the audit and conclusions and recommendations,  with exhibits and appendices.
(ii) Memoranda and documents analyzing portions or all of the insurance compliance audit report and discussing potential implementation issues.
(iii) An implementation plan that addresses correcting past noncompliance,  improving current compliance and preventing future noncompliance.
(iv) Analytic data generated in the course of conducting the insurance compliance audit.
(c) May include a written response to the findings of an insurance compliance audit and field notes and records of observations,  findings,  opinions,  suggestions,  conclusions,  drafts,  memoranda,  drawings,  photographs,  exhibits,  computer-generated or electronically recorded information,  phone records,  maps,  charts,  graphs and surveys if this supporting information is collected or developed for the primary purpose and in the course of an insurance compliance audit.
B. This article applies to insurance compliance audit documents prepared and insurance compliance audits conducted by or on behalf of an insurer licensed or regulated under this title including any:
1. Stock,  mutual,  reciprocal or title insurer.
2. Fraternal benefit society.
3. Health care services organization.
4. Hospital service corporation,  medical service corporation,  dental service corporation,  optometric service corporation or hospital,  medical,  dental and optometric service corporation.
5. Prepaid dental plan organization.
6. Mechanical reimbursement reinsurer.
7. Prepaid legal plan.
8. Lloyd's association.
9. Service company as defined in this title.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3321 - Definitions

20-3321.
Definitions
In this chapter,  unless the context otherwise requires:
1. " 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.
2. " 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.
(b) The error did not involve dispensing an incorrect dose or type of medication or dispensing a prescription drug to the wrong person.
3. " Desktop audit"  means an audit that is conducted by an auditing entity at a location other than the location of the pharmacist or pharmacy. Desktop audit includes an audit that is performed at the offices of the auditing entity during which the pharmacist or pharmacy provides requested documents for review by hard copy or by microfiche,  disk or other electronic media.
4. " 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.
5. " 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.
6. " List"  means the list of drugs for which a pharmacy benefit manager has established a maximum allowable cost.
7. " Maximum allowable cost" :
(a) Means the maximum amount that a pharmacy benefit manager will reimburse a pharmacy for the cost of a multisource drug.
(b) Does not include the dispensing fee for the drug.
8. " Pharmacist"  has the same meaning prescribed in section 32-1901.
9. " Pharmacy"  has the same meaning prescribed in section 32-1901.
10. " Pharmacy benefit manager"  means a person,  business or other entity that,  pursuant to a contract or under an employment relationship with an insurer or other third-party payor,  either directly or through an intermediary manages the prescription drug coverage provided by the insurer or other third-party payor,  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.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3322 - Audit procedures; interest prohibition

20-3322.
Audit procedures;  interest prohibition
A. The following procedures apply to an audit conducted by an auditing entity:
1. When conducting an in-pharmacy audit an auditing entity shall:
(a) Give a pharmacy at least fourteen days' written notice.
(b) Not conduct an audit during the first five days of the month unless the pharmacy otherwise consents.
(c) Provide the pharmacy a list of items to be audited that provides for identification of prescription number or numbers or date range that the auditing entity is seeking to audit.
(d) When conducting an in-pharmacy or desktop audit,  limit the audit to claims that may not exceed two years from the date that the claim was adjudicated by the pharmacy benefits manager.
2. An in-pharmacy audit or desktop audit that involves clinical or professional judgment shall be conducted by or in consultation with a pharmacist.
3. The pharmacy may use the records of a hospital,  physician or other authorized practitioner to validate the pharmacy records. The validated records may be obtained via electronic methods,  fax,  phone or written prescription orders and do not have to be the original hard copy prescription order.
4. Each pharmacy shall be audited under the same standards and parameters as other similarly situated pharmacies in this state.
B. When conducting an in-pharmacy audit or desktop audit,  an auditing entity shall comply with the following requirements:
1. The auditing entity shall base a finding of overpayment or underpayment on the actual overpayment or underpayment and not on a projection based on the number of patients served who have similar diagnoses or on the number of similar orders or refills for similar drugs,  unless required by federal or state law.
2. The auditing entity may not recoup monies from the pharmacy for any clerical errors identified in an audit.
3. Any finding of an overpayment may not include the dispensing fee amount unless any of the following criteria are met:
(a) A prescription was not received by the patient or the patient's designee.
(b) The prescriber denied authorization.
(c) The prescription dispensed was a medication error by the pharmacy.
(d) The identified overpayment is based solely on an extra dispensing fee.
C. Interest may not accrue during the audit period.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3323 - Audit reports

20-3323.
Audit reports
A. The auditing entity must deliver a preliminary audit report to the pharmacy within sixty days after the conclusion of the audit.
B. A pharmacy is allowed at least thirty days after receipt of the preliminary audit to provide documentation to address any discrepancy found in the audit.
C. Each auditing entity shall establish and make available to network pharmacies a written appeals process that shall include a process to appeal,  investigate and resolve disputes regarding final audit findings. A pharmacy shall have at least thirty days from the delivery of the final audit findings to appeal an unfavorable audit finding to the auditing entity. This written appeals process shall be included in all contracts between a pharmacy benefits manager and a network pharmacy or a pharmacy benefits manager and a pharmacy's contracting representative.
D. Each auditing entity shall provide a telephone number at which a network pharmacy may contact the pharmacy benefits manager and speak to someone who is responsible for processing appeals.
E. The auditing entity must deliver a final audit report to the pharmacy within ninety days after receipt of the preliminary audit report or final appeal,  whichever is later.
F. Chargebacks,  recoupment or other penalties may not be assessed until the appeals process has been exhausted and the final audit report has been issued.
G. Unless otherwise required by state or federal law,  audit information may not be shared with any entity other than the insurer on whose behalf the audit was conducted. Auditors may have access only to previous audit reports on a particular pharmacy conducted by that same auditing entity.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3324 - Applicability

20-3324.
Applicability
A. Notwithstanding any other law,  this article applies only to audits conducted of pharmacies located in this state.
B. This article does not apply to claims reviews that are initiated within three business days after transmission of a claim in which no chargeback or recoupment is demanded.
C. This article does not apply to an audit conducted in which a suspicion of fraudulent activity or other intentional and wilful misrepresentation is evidenced by physical review,  review of claims data,  statements or other investigative methods. The reason for an audit specified in this subsection shall be documented and available on request.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3331 - Pharmacy benefit managers; requirements; applicability

20-3331.
Pharmacy benefit managers;  requirements;  applicability
A. A pharmacy benefit manager shall do all of the following:
1. Update the price and drug information for each list that the pharmacy benefit manager maintains every seven business days.
2. At the beginning of the term of a contract,  on renewal of a contract and at least once annually during the term of a contract,  make available to each network pharmacy the sources used to determine maximum allowable cost pricing.
3. Establish a process by which a network pharmacy may appeal its reimbursement for a drug subject to maximum allowable cost pricing.
4. Allow a pharmacy services administrative organization that is contracted with the pharmacy benefit manager to file an appeal of a drug on behalf of the organization's contracted pharmacies.
B. Beginning on January 1,  2020,  this section applies to all new and existing contracts between a pharmacy benefit manager and a licensed pharmacy.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3332 - Prohibition against claim adjudication process fees; civil remedies

20-3332.
Prohibition against claim adjudication process fees;  civil remedies
A. A pharmacy benefit manager may not directly or indirectly,  on behalf of itself,  a plan sponsor or an insurer,  charge or hold a pharmacist or pharmacy responsible for a fee for any step of or component or mechanism related to the claims adjudication process,  including:
1. Adjudicating a pharmacy benefit claim.
2. Processing or transmitting a pharmacy benefit claim.
3. Developing or managing a claims processing or adjudication network.
4. Participating in a claims processing or adjudication network.
B. A pharmacy may submit a complaint of a violation of this chapter to the director. The pharmacy must include supporting documentation at the time the pharmacy files the complaint. The director shall investigate the complaint and may examine and audit the books and records of a pharmacy benefit manager to determine if the pharmacy benefit manager has committed a violation of this chapter. If the director finds that a pharmacy benefit manager has committed a violation of this chapter,  the director may:
1. Seek an injunction in a court of competent jurisdiction and may apply for temporary and permanent orders that the director determines are necessary to restrain the pharmacy benefit manager from continuing to commit the violation.
2. Issue a cease and desist order pursuant to section 20-456 on the pharmacy benefit manager.
C. A pharmacy benefit manager that commits a violation of this chapter is subject to the penalties prescribed in section 20-456.
D. In addition to the actions and penalties prescribed in subsections B and C of this section,  any person who is damaged by the acts of a pharmacy benefit manager committed in violation of this chapter may bring a civil action for damages against the pharmacy benefit manager committing the violation in a court of competent jurisdiction.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3334 - Records retention; schedule

20-3334.
Records retention;  schedule
(Eff. 1/1/25)
A. The director shall establish a retention schedule for all records,  books,  documentation and other data on file with the department related to the enforcement of this article.
B. The director shall not order the destruction or other disposal of any record,  book,  document or other data that is:
1. Required by law to be maintained.
2. Kept on file with the department until ten years have passed.
3. Filed during the director's administration or administrations.
C. All of the following apply to the records,  books,  documentation and other data obtained by the department:
1. The information is considered and treated as proprietary and confidential.
2. The information is not a public record and is exempt from title 39,  chapter 1.
3. The information is to be used only for the purpose of ensuring the pharmacy benefit manager's compliance with this article.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3341 - Definitions

20-3341.
Definitions
In this article,  unless the context otherwise requires:
1. " Drug coverage" :
(a) Means any form of compensation paid to a pharmacy that dispenses prescription drugs for a patient under a contractual or other legal obligation with a health insurer or pharmacy benefit manager.
(b) Does not include either of the following:
(i) Coverage provided pursuant to title 36,  chapter 29,  article 1.
(ii) Any amounts paid by an individual on his or her own behalf or on behalf of another individual without a contractual or legal obligation to do so.
2. " Health care plan"  has the same meaning prescribed in section 20-3151.
3. " Health insurer"  has the same meaning prescribed in section 20-242.
4. " Third party"  means a health insurer or pharmacy benefit manager that provides or manages drug coverage under a health care plan.
5. " 340B covered entity"  means an entity that participates in the 340B drug discount program authorized by 42 United States Code section 256b.
6. " 340B drug"  means a drug that is purchased by a 340B covered entity through the 340B drug discount program authorized by 42 United States Code section 256b and that is dispensed by a pharmacy.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3342 - Applicability

20-3342.
Applicability
A. This article applies to third parties that provide or manage drug coverage under a health care plan in this state.
B. This article does not apply to any of the following:
1. The Arizona health care cost containment system administration and its contractors as defined in section 36-2901 to the extent the services are provided pursuant to title 36,  chapter 29 or 34 or equivalent medicaid programs from other states.
2. The department of health services to the extent the services are provided under the AIDS drug assistance program.
3. Any individual or entity identified in section 36-2930.05.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3343 - 340B drug program; 340B covered entities; pharmacies; drug coverage

20-3343.
340B drug program;  340B covered entities;  pharmacies;  drug coverage
All contracts that are issued,  delivered or renewed on or after January 1,  2024 for a third party that reimburses for 340B drugs shall not do any of the following:
1. Discriminate in reimbursement on the basis that the pharmacy dispenses a 340B drug.
2. Assess any fee,  chargeback,  clawback or adjustment on the basis that a pharmacy dispenses a 340B drug.
3. Exclude a pharmacy from a third party's pharmacy network on the basis that the pharmacy dispenses a 340B drug.
4. Restrict the methods or pharmacies within a third-party network by which a 340B covered entity may dispense or deliver 340B drugs.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3402 - Prior authorization; exceptions

20-3402.
Prior authorization;  exceptions
A. A health care services plan or its utilization review agent may impose a prior authorization requirement for health care services provided to an enrollee,  except for emergency ambulance services and emergency services as specified in section 20-2803,  health care services arising after the initial medical screening examination and immediately necessary stabilizing treatment as specified in section 20-2803.
B. A health care services plan must allow at least one modality of medication-assisted treatment to be available without prior authorization.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3403 - Prior authorization requirements; disclosures; access

20-3403.
Prior authorization requirements;  disclosures;  access
A. If a health care services plan contains a prior authorization requirement,  all of the following apply:
1. The health care services plan or its utilization review agent shall make available to all providers on its website or provider portal a listing of all prior authorization requirements. The listing shall clearly identify the specific health care services,  drugs or devices to which a prior authorization requirement exists,  including specific information or documentation that a provider must submit in order for the prior authorization request to be considered complete.
2. The health care services plan or its utilization review agent shall allow providers to access the uniform prior authorization request forms approved by the department pursuant to section 20-3406 through the applicable electronic software system.
3. The health care services plan or its utilization review agent shall accept prior authorization requests through a secure electronic transmission.
4. The health care services plan or its utilization review agent shall provide at least two forms of access to request a prior authorization including telephone,  fax or electronic means and shall have emergency after-hours procedures.
B. The health care services plan or its utilization review agent shall accept and respond to prior authorization requests for prescription benefits through a secure electronic transmission.
C. The health care services plan or its utilization review agent may enter into a contractual arrangement with a provider under which the plan agrees to process and respond to prior authorization requests that are not submitted electronically because of the financial hardship that electronic submission of prior authorization requests would create for the provider or because internet connectivity is limited or unavailable where the provider is located.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3404 - Prior authorization requirement timelines

20-3404.
Prior authorization requirement timelines
A. If a plan offered by a health care services plan contains a prior authorization requirement,  all of the following apply:
1. For prior authorization requests concerning urgent health care services,  the health care services plan or its utilization review agent shall notify the provider of the prior authorization or adverse determination not later than five days after the receipt of all necessary information to support the prior authorization request.
2. For prior authorization requests concerning health care services that are not urgent health care services,  the health care services plan or its utilization review agent shall notify the provider of the prior authorization or adverse determination not later than fourteen days after receipt of all necessary information to support the prior authorization request.
3. On receipt of information from the provider in support of a prior authorization request,  the health care services plan or its utilization review agent shall provide a receipt in the same format that the request was made to the provider acknowledging that the information was received,  unless the necessary return contact information is not provided.
B. The notification required under subsection A of this section shall state whether the prior authorization request is approved,  denied or incomplete. If the prior authorization request is denied,  the health care services plan or its utilization review agent shall state the specific reason for the denial. For a request that is considered incomplete,  the provider shall have the opportunity to submit additional information. Once the provider submits additional information on incomplete requests,  the health care services plan has five days to review and respond to requests for health care services deemed urgent and fourteen days to review and respond to requests for health care services deemed not urgent.
C. A prior authorization request is deemed granted if a health care services plan or its utilization review agent fails to comply with the deadlines and notification requirements of this section.
D. A prior authorization request,  once granted or deemed granted,  is binding on the health care services plan,  may be relied on by the enrollee and provider and may not be rescinded or modified by a health care services plan or its utilization review agent after the provider renders the authorized health care services in good faith and pursuant to the authorization unless there is evidence of fraud or misrepresentation by the provider.
E. On a denial of a prior authorization request,  the enrollee and the provider may exercise the review and appeal rights specified in chapter 15,  article 2 of this title.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3405 - Prior authorization of prescription drugs for chronic pain conditions

20-3405.
Prior authorization of prescription drugs for chronic pain conditions
A. For a prior authorization request related to a chronic pain condition,  the health care services plan or its utilization review agent shall honor a prior authorization that is granted for an approved prescription drug for the earliest of the following:
1. Six months after the date of the prior authorization approval.
2. The last day of the enrollee's coverage under the plan.
B. In relation to a prior authorization described in subsection A of this section,  the health care services plan or its utilization review agent may request that the provider submit information to the health care services plan or its utilization review agent indicating that the enrollee's chronic pain condition has not changed and that the continuation of the treatment is not negatively impacting the enrollee's health. If the provider does not respond within five business days after the date on which the request was received,  the health care services plan or its utilization review agent may terminate the prior authorization.
C. This section does not apply to:
1. Prescription medications if the United States food and drug administration recommends that the drug be used only for periods of less than six months.
2. Any opioid or benzodiazepine or other schedule I or II controlled substance.
D. This section does not prohibit the substitution of any drug that has received a six-month prior authorization under subsection A of this section when there is a release of a United States food and drug administration-approved comparable brand product or a generic counterpart of a brand product that is listed as therapeutically equivalent in the United States food and drug administration's publication titled approved drug products with therapeutic equivalence evaluations.
E. This section does not prohibit a health care services plan from granting a prior authorization for a duration longer than six months.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3406 - Uniform prior authorization request forms; definition

20-3406.
Uniform prior authorization request forms;  definition
A. Notwithstanding any other law,  on or before January 1,  2022,  the department shall approve a uniform prior authorization request form for prescription drugs,  devices or durable medical equipment and a uniform prior authorization request form for all other health care procedures,  treatments and services. On or before January 1,  2023,  all providers shall use only the approved uniform prior authorization request forms and all health care services plans and utilization review agents shall accept and process prior authorization requests submitted using the approved uniform prior authorization request forms. Prior authorization requests that are submitted on or after January 1,  2023 are invalid unless the requests are submitted on the approved uniform prior authorization request forms. The uniform prior authorization request forms shall both:
1. Not exceed two printed pages. This two-page limit does not apply to or include a provider's notes or documentation that the provider submits in support of a prior authorization request.
2. Meet the electronic submission and acceptance requirements prescribed in section 20-3403.
B. In approving the uniform prior authorization request forms,  the department shall both:
1. Consider the following:
(a) Any existing prior authorization request forms that the centers for medicare and medicaid services or the United States department of health and human services has developed.
(b) Any national standards relating to electronic prior authorization.
(c) Any other form adopted by the director or another state agency.
2. Seek input from interested stakeholders,  including providers,  health care services plans,  utilization review agents,  pharmacists and pharmacy benefit managers.
C. This section does not prohibit a payor or any entity acting for a payor under contract with the payor from using a prior authorization methodology that uses an internet webpage,  an internet webpage portal or a similar electronic,  internet and web-based system if the methodology is consistent with the uniform prior authorization request forms approved by the director pursuant to this section.
D. For the purposes of this section,  " provider"  includes a health professional as defined in section 32-3218 or a health care institution that is licensed under title 36.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3451 - Definitions

20-3451.
Definitions
In this chapter,  unless the context otherwise requires:
1. " Applicant"  means a provider that submits a credentialing application to a health insurer to become a participating provider in the health insurer's network.
2. " Application"  means an applicant's initial application to be credentialed as a participating provider.
3. " Credentialing"  means to collect,  verify and assess whether a provider meets relevant licensing,  education and training requirements to become or remain a participating provider.
4. " Designee"  means a third party to whom the health insurer has delegated credentialing activities or responsibilities.
5. " Health insurer"  means a disability insurer,  group disability insurer,  blanket disability insurer,  health care services organization,  hospital service corporation,  medical service corporation or a hospital,  medical,  dental and optometric service corporation and includes the health insurer's designee. Health insurer does not include a pharmacy benefits manager as defined in section 20-3321.
6. " Loading"  means to input a participating provider's information into a health insurer's billing system for the purpose of processing claims and submitting reimbursement for covered services.
7. " Participating provider"  means a provider that has been credentialed by a health insurer or its designee to provide health care items or services to subscribers in at least one of the health insurer's provider networks.
8. " Provider"  means a physician,  hospital or other person that is licensed in this state or that is otherwise authorized to furnish health care services in this state.
9. " Recredentialing"  means to confirm that a participating provider is in good standing by a health insurer or its designee and does not require submitting an application or going through a contracting and loading process.
10. " Subscriber"  means a person who is eligible to receive health care benefits pursuant to a health insurance policy or coverage issued or provided by a health insurer.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3452 - Requirements for electronic application submission

20-3452.
Requirements for electronic application submission
A. A health insurer shall establish a process for the electronic submission of a credentialing application. On or before December 31,  2019,  the health insurers shall adopt and implement a standard application.
B. On or before December 31,  2019,  to the greatest extent possible,  a health insurer shall establish an electronic process to submit supporting documentation for a credentialing application.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3453 - Credentialing; loading; timelines; exception

20-3453.
Credentialing;  loading;  timelines;  exception
A. Except as provided in subsection C of this section,  the health insurer shall conclude the process of credentialing and loading the applicant's information into the health insurer's billing system within one hundred calendar days after the date the health insurer receives a complete application.
B. A health insurer shall provide written or electronic notice of the approval or denial of a credentialing application to an applicant within seven calendar days after the conclusion of the credentialing process.
C. If a licensed health care facility has a delegated credentialing agreement with a health insurer,  the health insurer is not responsible for compliance with the timeline prescribed in subsection A of this section for an applicant who works for that facility,  but shall conclude the loading process for that applicant within ten calendar days after the health insurer receives a roster of demographic changes related to newly credentialed,  terminated or suspended participating providers.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3454 - Acknowledgement of receipt of an application; notification of incomplete applications

20-3454.
Acknowledgement of receipt of an application;  notification of incomplete applications
A. A health insurer shall provide written or electronic acknowledgement to an applicant within seven calendar days after the health insurer's receipt of the applicant's application. The applicant shall include in the application a contact name,  telephone number and e-mail address to address discrepancies in the application.
B. On receipt of an application,  a health insurer shall promptly review the application to determine if the application is complete.
C. If the health insurer determines that the application is incomplete,  the health insurer shall notify the applicant in writing or by electronic means that the application is incomplete within seven calendar days after the date the health insurer received the application. The notice shall include a detailed list of all of the items required to complete the application. A health insurer may request supplemental information to complete the credentialing process.
D. If the health insurer does not send the notice to the applicant within the required time frame specified in this section,  the application is deemed complete for the purposes of section 20-3453.
E. If the health insurer notifies the applicant of an incomplete application in compliance with subsection C of this section,  the time periods specified under section 20-3453 are tolled,  and the application is suspended from the date the notification was sent to the applicant until the date on which the health insurer receives the information from the applicant to complete the application. If the health insurer has not received any response providing the requested information in subsection C of this section from the applicant after thirty calendar days,  the insurer may deem the application withdrawn.
F. On receipt of a complete application,  a health insurer must send the applicant a proposed contract that is complete and ready for execution by the parties.
G. A health insurer that enters into a delegated credentialing agreement with a licensed health care facility or that participates in a health insurer credentialing alliance with equivalent or higher standards than as prescribed in this section is deemed to be in compliance with the requirements of this section.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3455 - Reported discrepancies; corrective action

20-3455.
Reported discrepancies;  corrective action
A health insurer shall take reasonable steps to correct discrepancies in the provider or network plan directory within thirty calendar days after receiving a written or electronic report of the discrepancy from a participating provider. A participating provider shall notify a health insurer of any change in the provider's name,  address,  telephone number,  business structure or tax identification number within ten business days after making the change.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3457 - Availability of credentialing information; policies

20-3457.
Availability of credentialing information;  policies
A. A health insurer shall make the following nonproprietary information available to all applicants for credentialing and shall post the information on its website:
1. The applicable credentialing policies and procedures.
2. A list of all the information required to be included in an application.
3. A checklist of materials that must be submitted in the credentialing process.
4. Designated contact information,  including a designated point of contact,  an e-mail address and a telephone number to address any credentialing inquiries.
B. On completion of the credentialing process,  a health insurer shall make all nonproprietary information pertaining to a provider's credentialing application and final decision available to the applicant on request,  if allowed by law.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3458 - Recredentialing

20-3458.
Recredentialing
A. A health insurer or its designee may recredential participating providers at least once every thirty-six months and more frequently if required by federal or state law or the health insurer's accreditation standards,  or if permitted by the health insurer's contract with the participating provider. Nothing in this section shall affect the contract termination rights of a health insurer or a participating provider.
B. A participating provider remains credentialed and loaded in the health insurer's billing system unless the health insurer discovers information that would result in the participating provider ceasing to meet the health insurer's guidelines for participation,  in which case the health insurer shall provide the participating provider a written explanation for the change in status.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3459 - Civil immunity; enforcement; civil penalty

20-3459.
Civil immunity;  enforcement;  civil penalty
A. A health insurer that complies in good faith with the requirements of this chapter is immune from civil liability for the purposes of reviewing and approving a credentialing application.
B. The director shall enforce this chapter. A health insurer that fails to comply with this chapter or with any rules adopted pursuant to this chapter is subject to the civil penalties prescribed in section 20-456.
C. On receipt of multiple complaints of violations of this chapter by a health insurer from applicants or participating providers,  the director shall conduct an examination of the health insurer pursuant to section 20-156,  20-831 or 20-1058,  as applicable to the specific insurer.
2023 Arizona Revised Statutes › Title 20 - Insurance › § 20-3501 - Definitions

20-3501.
Definitions
In this chapter,  unless the context otherwise requires:
1. " Classification of benefits"  means the following classifications of benefits provided by a health plan:
(a) Inpatient,  in-network.
(b) Inpatient,  out-of-network.
(c) Outpatient,  in-network.
(d) Outpatient,  out-of-network.
(e) Emergency care.
(f) Prescription benefits.
2. " Health care insurer"  means a disability insurer,  group disability insurer,  blanket disability insurer,  health care services organization,  hospital service corporation,  medical service corporation or hospital,  medical,  dental and optometric service corporation that issues a health plan in this state.
3. " Health plan"  means an individual health plan or accountable health plan that provides mental health services or mental health benefits,  that finances or provides covered health care services,  that is issued by a health care insurer in this state and that is subject to the mental health parity and addiction equity act.
4. " Mental health parity and addiction equity act"  means the mental health parity and addiction equity act of 2008 (42 United States Code section 300gg-26) and implementing regulations.
5. " Product network type"  means the network model associated with the type of health plan under which covered health care is delivered,  such as a health care services organization,  preferred provider network organization,  point of service plan or indemnity plan.
6. " Treatment limits" :
(a) Means limits on benefits based on the frequency of treatment,  number of visits,  days of coverage,  days in a waiting period or other similar limits on the scope or duration of treatment.
(b) Includes both quantitative treatment limits that are expressed numerically and nonquantitative treatment limits that otherwise limit the scope or duration of benefits for treatment under a health plan.
(c) Does not include a permanent exclusion of all benefits for a particular condition or disorder.