Search state statutes and regulations in all 50 states and the District of Columbia to find out what rights you have in your state and what other states are doing to empower physicians and patients in the face of health insurer market power.
Restrictions on Authorizations When Service Timely Rendered; Timely Notification of Prior Authorization or Adverse Determination; Notification Time for Prior Authorization or Adverse Determination; Honoring of Prior Authorizations; Noncompliance Resulting in Automatic Authorization
Definitions; Documented prior authorization program, requirements; Timeframes for determinations, concurrent review, retrospective review, adverse determination; Documentation; Utilization review, determinations, appeals; Prior authorization, denial of claims; Reviews for fraud, waste or abuse
Application of Chapter; “Adverse Determination;” “Covered individual;” “CPT Code;” “Health Care Service;” “Health Plan;” “Participating Provider;” “Prior Authorization;” “Urgent Care Situation;” Availability of Prior Authorization Information; Requirements; New Requirements; Address Change; Notices; Request for Prior Authorization; Electronic Transmission; Standardized Form; Response to Request for Prior Authorization; Timing; Incomplete Request; Claim for Which Prior Authorization Was Given; Denial; Resubmission of Claim; Unanticipated, Medically Necessary Health Care Service; Denial; CPT codes exempt from prior authorization; Payment for Health Care Service With Prior Authorization; Contrary Contract Provision Void; Peer to peer review.
Requests for prior authorization — Qualified persons authorized to review and approve — Adverse determinations to be made only by Arkansas-licensed physicians-— Opportunity to discuss treatment before adverse determination
Short title; Part definitions; Requirements for initial adverse determinations; Appeals of an electronic and non-electronic initial adverse determination; Prior authorization submissions; Chronic conditions; Clinical criteria; Electronic prior authorization; Expiration date for a prior authorization; Prior authorization and opioid use disorder; Medical necessity; Changing prior authorization requirements; Payment; Prior authorization transfers; Related service; Reviewer criteria; Statistics; Prior authorization requirements; Website notice requirements; Applicability; Provider notification to health carrier; Rules.
Definitions; Operational standards; Medical policies and clinical review criteria; Prior authorization review
Standard electronic prior authorization transaction process; requirements; adverse determination process; denial and appeals; standard report; modification program; definitions.