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Arkansas Code Title 23. Public Utilities and Regulated Industries § 23-99-1105. Prior authorization--Nonurgent healthcare service

Current as of March 28, 2024 | Updated by Findlaw Staff

(a) If a utilization review entity requires prior authorization of a nonurgent healthcare service, the utilization review entity shall make an authorization or adverse determination and notify the subscriber and the subscriber's nonurgent healthcare provider of the decision within two (2) business days of obtaining all necessary information to make the authorization or adverse determination.

(b) For purposes of this section, “necessary information” includes the results of any face-to-face clinical evaluation or second opinion that may be required.

(c)(1) If a utilization review entity denies a prior authorization of a nonurgent healthcare service, then the subscriber or the healthcare provider may elect to appeal the denial of the prior authorization of the nonurgent healthcare service.

(2) If a denial of a prior authorization of a nonurgent healthcare service is appealed to the utilization review entity, then within four (4) business days of receiving all necessary information required, the utilization review entity shall:

(A) Make an authorization or adverse determination; and

(B) Notify the subscriber and the healthcare provider that appealed the denial of the prior authorization of the nonurgent healthcare service of the decision.

(3) This subsection applies to an enrollee who is being evaluated or treated for:

(A) A hematology diagnosis;

(B) An oncology diagnosis; or

(C) An additional disease state or other diagnoses that the Insurance Commissioner may include by rule.

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Cite this article: FindLaw.com - Arkansas Code Title 23. Public Utilities and Regulated Industries § 23-99-1105. Prior authorization--Nonurgent healthcare service - last updated March 28, 2024 | https://codes.findlaw.com/ar/title-23-public-utilities-and-regulated-industries/ar-code-sect-23-99-1105/

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