Arizona Revised Statutes Title 20. Insurance § 20-3101. Definitions

1. “Adjudicate” means an insurer's decision to deny or pay a claim, in whole or in part, including the decision as to how much to pay.

2. “Clean claim” means a written or electronic claim for health care services or benefits that may be processed without obtaining additional information, including coordination of benefits information, from the health care provider, the enrollee or a third party, except in cases of fraud.

3. “Enrollee” means an individual who is enrolled under a health care insurer's policy, contract or evidence of coverage.

4. “Grievance”:

5. “Health care insurer” means a disability insurer, group disability insurer, blanket disability insurer, health care services organization, prepaid dental plan organization, hospital service corporation, medical service corporation, dental service corporation, optometric service corporation, or hospital, medical, dental and optometric service corporation.