Arizona § 20-3451 Definitions

Arizona Statutes

§ 20-3451 — Definitions

Arizona § 20-3451

Title 20Arizona Revised Statutes

Ch. 27PROVIDER CREDENTIALING

Art. 1General Provisions

This text of Arizona § 20-3451 (Definitions) is published on Counsel Stack Legal Research, covering Arizona primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Ariz. Rev. Stat. Ann. § 20-3451 (2026).

Text

(L18, Ch. 238, sec.

4.Eff.until4/1/26) 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 orga

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(L18, Ch. 238, sec. 4. Eff.until4/1/26)

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.