Requests for prior authorization — Qualified persons authorized to review and approve — Adverse determinations to be made only by Arkansas-licensed physicians

  1. Law
  2. Arkansas Code
  3. Public Utilities and Regulated Industries
  4. Insurance
  5. Healthcare Providers
  6. Prior Authorization Transparency Act
  7. Requests for prior authorization — Qualified persons authorized to review and approve — Adverse determinations to be made only by Arkansas-licensed physicians

Checkout our iOS App for a better way to browser and research.

  1. (a) The initial review of information submitted in support of a request for prior authorization may be conducted by a qualified person employed or contracted by a utilization review entity.

  2. (b) A request for prior authorization may be approved by a qualified person employed or contracted by a utilization review entity.

  3. (c)

    1. (1) An adverse determination regarding a request for prior authorization shall be made by a physician who possesses a current and unrestricted license to practice medicine in the State of Arkansas issued by the Arkansas State Medical Board.

    2. (2)

      1. (A) A utilization review entity shall provide a method by which a physician may request that a prior authorization request be reviewed by a physician in the same specialty as the physician making the request, by a physician in another appropriate specialty, or by a pharmacologist.

      2. (B) If a request is made under subdivision (c)(2)(A) of this section, the reviewing physician or pharmacologist is not required to meet the requirements of subdivision (c)(1) of this section.


Download our app to see the most-to-date content.