Information required with application

  1. Law
  2. Arkansas Code
  3. Public Health and Welfare
  4. Health and Safety
  5. Health Facilities and Services Generally
  6. Utilization Review
  7. Information required with application

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In conjunction with the application, the private review agent shall submit information that the State Board of Health requires, including:

  1. (1) A utilization review plan that includes:

    1. (A) A description of review standards and procedures to be used in evaluating proposed or delivered hospital and medical care; and

    2. (B) The provisions by which patients, physicians, or hospitals may seek reconsideration or appeal of adverse decisions by the private review agent;

  2. (2) The type and qualifications of the personnel either employed or under contract to perform the utilization review;

  3. (3) The procedures and policies to ensure that a representative of the private review agent is reasonably accessible to patients and providers five (5) days a week during normal business hours in this state;

  4. (4) The policies and procedures to ensure that all applicable state and federal laws to protect the confidentiality of individual medical records are followed;

  5. (5) A copy of the materials designed to inform applicable patients and providers of the requirements of the utilization review plan; and

  6. (6) A list of the third party payors for which the private review agent is performing utilization review in this state.


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