Utilization Review Licensing in Arizona

$0

Contact the Life and Health Division at 602-364-2393 for application forms.

• A certificate of good standing from the Arizona Corporation Commission.
• A copy of a national UR accreditation certificate (URAC, NCQA or AAGC) if applicable.
• A utilization review plan that includes a summary description of review guidelines, protocols and procedures, standards and criteria to be used in evaluating inpatient hospital care, inpatient medical care, outpatient surgical care and any medical, surgical and health care services that may be covered by a health care insurer and the provisions by which patients, providers or hospitals may seek reconsideration or appeal of decisions made by the utilization review agent.
• A list of all contracts (if any) the entity has with a health care insurer or third party administrator to conduct utilization review for fully insured commercial plans in Arizona.
• A copy of the materials or a description of the procedure designed to inform patients and providers, as appropriate, of the requirements of the utilization review plan.

$0

Triennially by the anniversary of certification.

Email to UtilizationReview@azinsurance.gov.

$0

Annually by March 1. Attestations may be filed as early as January 1.

Contact the department for an attestation form.

• If there have been material changes to the UR Plan or appeals process, submit the updated information in redline format. If there have been no changes provide a statement to that effect.
• Provide the name, phone number and email address of three company contacts including the Medical Director and the UR or QI Director/Manager
• Attach a copy of your current URAC, NCQA and/or AAAHC Certificate(s) of Accreditation.