Ariz. Admin. Code § 20-5-1302
In this Article and R20-5-106(A)(12), unless the context otherwise requires:
"Act" means the Arizona Workers' Compensation Act, A.R.S. Title 23, Chapter 6.
"Active Practice" means performing patient care for a minimum of eight hours per week in one of the five preceding years.
"Administrative Law Judge" or "ALJ" means a hearing officer appointed under A.R.S. § 23-108.02.
"Administrative Review" means a process that includes a peer review for preauthorization of a request for medical treatment or services conducted pursuant to R20-5-1311. The administrative review process will be managed by the Medical Resource Office (MRO) at the Industrial Commission of Arizona.
"American Board of Medical Specialties" means the organization that develops a uniform system for specialty boards to administer examinations for certification of physicians within specific medicine specialties.
"American Osteopathic Association" means the organization that develops a uniform system for specialty boards to administer examinations for certification of osteopathic physicians within specific osteopathic medicine specialties.
"Applicability" means the body parts and medical conditions that are covered under this Article and authorized by the Commission under R20-5-1301(B) and (C).
"Claim" means the workers' compensation claim filed by the injured employee under the Act.
"Contractor" means an independent peer review organization accredited by URAC.
"Fast Track ALJ Dispute Resolution Program" or "fast track process" means the voluntary dispute resolution process set forth in R20-5-1312(B).
"International Classification of Diseases Code" or "ICD Code" means a set of medical diagnostic codes that creates a universal language for reporting diseases and injury.
"International Classification of Diseases" or "ICD" means an official list of categories of diseases, physical and mental, that is issued and maintained by the World Health Organization.
"IME" means an independent medical examination scheduled under R20-5-114.
"Injured Employee" means a person defined in A.R.S. § 23-901 whose claim has been accepted for workers' compensation benefits.
"Medical File Review Opinions" means a formal examination of patient data and medical records for the purpose of determining the need for medical treatment, services or both.
"Payer" means an insurance carrier defined under A.R.S. § 23-901, a self-insured employer defined in R20-5-102, a third-party administrator, and the Special Fund of the Industrial Commission of Arizona.
"Peer Review" means an independent medical review conducted by an individual meeting the requirements of R20-5-1311(I).
"Preauthorization" means the written request prescribed by R20-5-1303 from a provider to a payer requesting approval to provide medical treatment or services to an injured employee.
"Provider" means a physician as defined in R20-5-102.
"Reconsideration" means a written request to the payer or identified review organization by an injured employee or medical provider to reconsider a previous payer decision to deny medical treatment or services and that identifies the specific justification to support the request.
"Third-Party Administrator" means an organization that processes insurance or employee benefit claims for a separate entity.
"Treatment Guidelines" or "guidelines" means medical treatment guidelines that are used as a tool to support clinical decision making and quality health care delivery to injured employees.
"URAC" refers to URAC, a non-profit organization formerly known as the Utilization Review Accreditation Commission.
Ariz. Admin. Code § R20-5-1302