Uniform billing; third party payors; exception; definitions

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36-125.07. Uniform billing; third party payors; exception; definitions

A. A person, including a third party payor, who is obligated to pay a charge for any item or service that is subject to the uniform billing requirements of section 36-125.05 shall accept such billing as its principal billing format.

B. A person, including a third party payor, who is obligated to pay a charge for any item or service may require that a hospital subject to the uniform billing requirements of section 36-125.05 submit existing supplemental information in conjunction with the uniform billing form in order to substantiate billing for emergency services. Except for the Arizona health care cost containment system and counties providing indigent health care as defined in subsection D, paragraphs 13 and 14 of this section, such person shall pay the reasonable cost to the hospital of reproducing such supplemental information that shall be related solely to such emergency services.

C. For purposes of this section:

1. " Person" includes this state, any of its agencies, boards or commissions, any political subdivision of this state and any agency, board or commission of any such political subdivision.

2. " Third party payor" means any person obligated to pay for items or services provided to another. Third party payor includes the following:

(a) Insurers as defined in section 20-104, including any insurer transacting any kind of insurance defined in title 20, chapter 2, article 2.

(b) Hospital, medical, dental and optometric service corporations as defined in section 20-822.

(c) Fraternal benefit societies as defined in section 20-861.

(d) Prepaid dental plan organizations as defined in section 20-1001.

(e) Health care services organizations as defined in section 20-1051.

(f) Any person writing disability insurance policies subject to title 20, chapter 6, article 4.

(g) Any person writing group or blanket disability insurance policies subject to title 20, chapter 6, article 5.

(h) Providers of life care contracts as defined in section 20-1801.

(i) Insurance carriers as defined in section 23-901.

(j) Insurance carriers writing motor vehicle liability policies.

(k) The Arizona health care cost containment system established pursuant to chapter 29 of this title.

(l) Counties providing indigent health care.

(m) Self-insured persons.


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