Ariz. Admin. Code § R20-6-1805 - Required Reporting

A. On or before March 1 of each year, an Organization shall submit the following information to the Department for the previous calendar year:

1. Member satisfaction survey results and supporting data;

2. A spreadsheet that lists the name, address, and telephone number of each provider and whether the provider: is accepting new members, is a general dentist or specialist, and has graduated from a specialty graduate program accredited by the American Dental Association;

3. A list of all contracted network general dentists and specialists that have been added or deleted since the previous annual report;

4. The total number of members and the number of members assigned to each general dentist's office;

5. The average member wait time measured in weeks for an appointment for each network dentistry office; and

6. A website link to its current provider directory.

B. An Organization shall provide the following information about the prepaid dental plan to the Department quarterly:

1. The total number of members and the number of members assigned to each general dentist's office;

2. A list of all contracted network general dentists and specialists that notes those who have been added or deleted since the previous quarterly report;

3. Verification that each specialist added to the network since the last quarterly report has graduated from a specialty graduate program accredited by the American Dental Association; Documentation of the Organization's quality improvement activities, including the number of providers who have been credentialed or re-credentialed since the last quarterly report, the number of facility reviews, and the number of chart reviews;

4. The average wait time measured in weeks for an appointment for each network dentistry office;

5. A copy of the current provider directory; and

6. A complaint log with a summary of Organization responses by complaint category.

If a network dental office that is open to new members has an appointment wait time of longer than nine weeks for three consecutive calendar quarters, the Organization shall report to the Director who may require the Organization to close the office to new members until the wait time is less than nine weeks.

C. An Organization shall submit the following information to the Department at least annually:

1. Member satisfaction survey results and supporting data;

2. Results of a survey of network general dentistry offices with supporting data confirming a recall system under R20-6-1809(B)(2) ;

3. An electronic database that lists the name, address, and telephone number of each provider and whether the provider is accepting new members. The Organization shall submit the database for general dentists and specialists separately. The Organization shall submit any changes to this database to the Department quarterly; and

4. A report that compiles all the copays listed in all the schedules of benefits offered by the Organization, with comparisons of the copays to the usual, customary, and reasonable fees, as determined by the Organization, for the procedures listed on the schedule of benefits.

Notes

Ariz. Admin. Code § R20-6-1805

New Section made by final rulemaking at 8 A.A.R. 463, effective January 10, 2002 (Supp. 02-1). Amended by final rulemaking at 27 A.A.R. 654, effective 5/7/2022.