Benefit inquiries subject to prior authorization requirements
Arkansas Code § 23-61-108; Arkansas Code § 23-99-1113; Arkansas Code § 23-99-1118
- (a) Pursuant to Arkansas Code § 23-99-1113(a)(2)(A), the following benefit inquiries are subject to the requirements of Arkansas Code § 23-99-1113.
(b)
- (1) Any utilization review entity responding to a benefit inquiry in which the healthcare provider's billed charge for such services exceeds one thousand five hundred dollars ($1,500) shall comply with the Prior Authorization Transparency Act, Arkansas Code § 23-99-1101 et seq.
- (2) No utilization review entity shall be required to provide a healthcare provider with a response under the Prior Authorization Transparency Act if a healthcare plan or policy is not in force at the time of such inquiry, or in the event that the member is not covered or insured under such plan at the time of such inquiry.
- (3) A utilization review entity may require the healthcare provider to provide information in the inquiry describing the member or healthcare plan identification to expedite the inquiry.