Governance
Medical director
Arizona-licensed physician who reviews and signs denials.
Definition
A physician who must hold an active, unrestricted license to practice medicine in Arizona and who is required to individually review and personally sign any prior authorization denial based on medical necessity; the role creates professional accountability subject to the Arizona Medical Board.
Related Terms
Medical necessity
Standard for determining appropriateness of a service....
Written denial
Documented denial including explanation and physician signature....
Prior authorization
Insurer approval required before certain services are covered....
Independent Auditor
Auditor without recent business ties to the employer or AEDT vendor....
Designated individual
Named person responsible for organizational privacy compliance....