Ariz. Admin. Code § R20-5-1406 - Cancer Reporting; Required General Data Elements
A. Name of Data Provider
(i.e., What entity is reporting the data?): The name of the
insurance carrier, self-insured employer, self-insurance pool, or designee
submitting the cancer-related claim data.
B. Data Provider Type Code: Insurance
Carrier; Self-Insured Employer; Self-Insurance Pool; Third-Party Administrator;
or Other Designee.
C. Name of
Person Submitting Data: The name of the individual submitting the
cancer-related claim data.
D. Name
of Data Provider Primary Contact: The name of the individual designated by the
Data Provider who can be contacted regarding the data submission. (May be the
same as the "Name of Person Submitting the Data.")
E. Data Provider Primary Contact Phone
Number: The phone number of the Data Provider Primary Contact.
F. Data Provider Primary Contact Email
Address: The email address of the Data Provider Primary Contact.
G. Loss valuation date: The last day of the
12-month reporting period.
H. Total
Number of New Cancer-Related Claims: Total number of cancer-related claims
filed by or on behalf of firefighters and fire investigators during the
applicable reporting period (whether or not the claims are included in the
detailed reporting).
1. Accepted: Total
number of new cancer-related claims accepted during the applicable reporting
period.
2. Denied: Total number of
cancer-related claims denied during the applicable reporting period.
3. Pending: Total number of cancer-related
claims pending decision on the applicable loss valuation date.
Notes
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