Ariz. Admin. Code § 20-6-1804

Current through Register Vol. 30, No. 45, November 8, 2024

Section R20-6-1804 - Dental Director

A. The governing authority or CEO shall appoint as the Organization's dental director a dentist licensed to practice dentistry in any state or territory of the United States or the District of Columbia.

B. The dental director shall perform at least the following functions for the Organization's geographic area in Arizona:

1. Participate on the Organization's quality improvement committee required under Section R20-6-1811;

2. Oversee the Organization's program and processes for:

a. Maintaining and improving clinical quality of care, including continuity of care;

b. Provider relations;

c. Facility and dental record reviews; and

d. Provider credentialing and recredentialing;

3. Be knowledgeable about and participate in decisions regarding the Organization's operations;

4. Comply with A.R.S. § 20-2510(B) and (C) when directly denying, on the basis of medical necessity, a health care provider's request for prior authorization; and

5. Timely respond to matters within the Organization's Arizona geographic area that require personal onsite attention or ensure that a designee who meets the requirements specified in subsection (D) timely responds to those matters.

C. Matters that require personal onsite attention include:

1. Urgent patient care issues that require examination of dental records or X-rays;

2. Prompt personal discussion with a provider of urgent concerns relating to credentialing, disciplinary problems, access to care, or quality of care.

D. Any designee acting under subsection (B)(5) shall:

1. Be a dentist licensed to practice dentistry in any state or territory of the United States or the District of Columbia;

2. Have expedient access to the dental director, the CEO, and other organization management personnel as necessary to resolve any matter requiring personal onsite attention; and

3. Have the education, experience, and Organizational knowledge required to address the matter requiring personal onsite attention.

E. The Organization shall notify the Department in writing within ten days after the effective date of a change in the appointment of the dental director or any designee.

F. The requirements for a designee under subsections (B)(5), (D), and (E) shall not apply to an Organization with fewer than 2,000 members in Arizona.

Ariz. Admin. Code § R20-6-1804

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.