Ariz. Admin. Code § 20-6-1912

Current through Register Vol. 30, No. 49, December 6, 2024

Section R20-6-1912 - [Effective until 1/5/2025] Network Directories

A. An HCSO shall publish a provider network directory as follows:

1. An HCSO shall list the name, address, telephone number, specialty, and hospital affiliation for all in-area contracted physicians or practitioners.

2. An HCSO may list ancillary providers by corporate or group name and is not required to list individual physicians or practitioners.

3. An HCSO is not required to list physicians or practitioners in the following areas of specialties or areas of practice:

a. Emergency medicine;

b. Anesthesiology, except anesthesiologists who provide pain management services;

c. Hospital-based pathology;

d. Hospital-based radiology; and

e. Hospitalists.

4. An HCSO that lists any of the physicians or practitioners in subsections R20-6-1912(A)(3)(a) through (A)(3)(e) may list by corporate or group name and is not required to list individual physicians or practitioners.

5. An HCSO that uses hospitalists is not required to list the hospital affiliations of PCPs who do not admit or attend hospitalized members.

6. An HCSO shall publish a provider network directory that lists all its contracted facilities and contains:

a. The name, address, and telephone number of each facility;

b. For each hospital at which the HCSO uses hospitalists, if any, a statement that the HCSO uses hospitalists at that hospital;

c. For an HCSO that uses hospitalists and does not list them in the directory, information on how an enrollee can find out what hospitalists or group of hospitalists it uses at each hospital;

B. The network directory shall conspicuously state in the directory the following:

1. Changes occur in the network after the directory is published and some providers listed in the directory may no longer be contracted,

2. Enrollee coverage may depend on the contract status of the provider,

3. Where the enrollee can obtain more recent directory information,

4. The effective date of the network directory, and

5. The method for an enrollee or prospective enrollee to find out which PCPs are accepting new enrollees from the HCSO.

C. Each HCSO shall make its network directory available on paper to enrollees or prospective enrollees requesting it. The HCSO shall:

1. Publish the paper directory at least once a year;

2. Update or supplement the information in the paper directory at least every six months;

3. Explain in the paper directory how an enrollee or prospective enrollee can use or get assistance using the HCSO's online or telephone directories, if any; and

4. Have discretion to list physicians' or practitioners' hospital affiliations in its paper directory.

D. Each HCSO that has an online network directory shall:

1. Update the online directory at least monthly;

2. Make the online directory easy to use and user friendly; and

3. Explain, in the online directory, how an enrollee or prospective enrollee can obtain a paper directory.

Ariz. Admin. Code § R20-6-1912

New Section made by final rulemaking at 11 A.A.R. 4861, effective December 31, 2005 (Supp. 05-4).