LICENSES
In Arizona, which state agency is responsible for regulating the licensure of physicians?
What is: the AZ Medical Board
During the credentialing process, what is the term for verifying a physician's qualifications directly with the issuing entity?
What is PSV -primary source verification
What does AHCCCS stand for?
What is: AZ Healthcare Cost Containment System
AZ law mandates that physicians must report any malpractice settlements or judgments with how many days to the AZ Medical Board?
What is: 30 days
What does CAQH stand for?
What is: Council for Affordable Quality Healthcare
What is the max duration for which a physician's license can be issued in AZ before requiring renewal?
What is: 2 years
According to AZ credentialing procedures, what is the required amount of continuing medical education (CME) hours a physician must complete every 2 years to maintain their license?
What is: 40 hours every 2 years
What does the term formulary mean in a managed care plan?
What is: the list of prescription drugs covered by the health plan, often grouped into tiers
According to NCQA, what is one key practice that health plans must follow to maintain high quality of care?
What is: conducting regular audits of providers
What does NCQA stand for?
What is: National Committee for Quality Assurance
What is the required educational degree for Nurse Practitioners to become licensed in Arizona?
What is: master's or doctoral in nursing
In the context of credentialing, what does the acronym NPDB stand for?
What is: The National Practitioner Data Bank
What type of health care plan typically requires its members to choose a primary care physician (PCP) and get referrals to specialists?
What is: HMO - Health Maintenance Organization
What is the difference between Medicaid & Medicare?
What is: Medicaid is funded by the state and Medicare is funded by the federal government
What does HIPAA Stand for?
What is: Health Insurance Portability and Affordability Act
In Arizona, what is the maximum number of physician assistants that any one physician can supervise?
What is: total of 6 max
What is the term for the process of granting a physician permission to provide certain medical services in a specific facility or organization?
What is: privileging
What do you call the type of payment arrangement where healthcare providers are paid a fixed amount per patient, regardless of the number of services provided?
What is: capitation
Arizona requires healthcare providers to report adverse events to a regulatory body. Which organization must be notified in these cases?
What is: the AZ Dept of Health Services (ADHS)
What does ABMS stand for?
What is: American Board of Medical Specialties
How long must a PA in Arizona practice under a supervising physician agreement before being eligible for independent practice?
What is - there is no fully independent practice for PAs in Arizona, they must always have a supervising agreement.
What document is used to prove current competency?
What is: case logs
In AZ, what is the program called that offers the behavioral health services for AHCCCS?
What is: the RHBA - Regional Behavioral Health Authority
NCQA requires health plans to have a policy of managing continuity of care. What does continuity of care mean?
What is: ensuring that members receive continuous care when transitioning between providers or changing health plans
What does PECOS stand for?
What is: Provider Enrollment, Chain, and Ownership System