Ariz. Admin. Code § 20-5-1305

Current through Register Vol. 30, No. 50, December 13, 2024

Section R20-5-1305 - Payer Denial of Payment for Provided Treatment or Services

A. A payer shall not deny payment for provided treatment or services solely because the guidelines do not address the requested treatment or services.

B. A payer shall not deny payment for provided treatment or services supported by the guidelines, unless the payer can rebut the presumption of reasonableness and correctness with a medical or psychological opinion establishing by a preponderance of the evidence that there is a medical contraindication or significant medical or psychological reason not to pay for the treatment or services.

C. A dispute related to a payer's failure to pay for provided treatment or services may be processed as a request for investigation under A.R.S. § 23-1061(J) if filed by an injured employee.

Ariz. Admin. Code § R20-5-1305

Adopted by final rulemaking at 22 A.A.R. 1730, effective 10/1/2016.