Health care providers in Arizona have rules when submitting to insurance companies.
Arizona requirements for health care provider billing, governed by state and federal laws, are designed to protect the confidentiality of patient medical records and to provide procedures for insurance companies and health providers in submitting claims and processing payments. Arizona also has laws in effect that governs the adjudication of companies that fail to pay lawfully submitted claims.
Co-Payments and Deductibles
A co-payment is the percentage or fixed financial number your health insurance company requires you to pay per doctor visit, prescription drug purchase or other medical service. In Arizona, your health care provider may request this co-payment before services are extended or immediately following your visit. This co-payment is then deducted from the bill that is sent to your health insurance company by your health care provider.
HIPAA Privacy Rules
Health care providers are required to comply with all standards established by the Health Insurance Portability and Accountability Act for medical billing. This means that patient confidentiality and medical records may only be viewed by personnel on a "medically relevant" basis.
Health insurance companies in Arizona may only view patient medical records to make coverage determinations. As such, health care providers are duty bound under HIPAA to keep patient charts, medical records and treatment progress confidential unless the patient gives consent otherwise.
National Provider Identification Numbers
Health care providers that submit claims to health insurance companies are required to have a national patient identification number. This number maintains the privacy of patient records when submitted electronically and carries a health care provider's identifying information to the insurance provider.
Doctors and other health care providers in Arizona are not required to have an NPI number; however, health care providers that do not have one cannot submit claims to Medicare or other insurance providers.
Timely Pay Laws
Arizona timely pay laws require that health insurance companies must reimburse health care providers for services extended to clients in a reasonable amount of time. Health care providers are able to file a grievance with the Arizona Department of Insurance against insurance providers that do not pay out claims quickly or outright refuse to. Under the law, insurers have 30 days to pay claims to health care providers.
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