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23-86-123. Prior authorization by physician — Definitions.
Arkansas Code — all titles (historical 2020) · legal_authorities
23-86-123. Prior authorization by physician — Definitions.
(a) As used in this section:
(1) “Prior authorization” means the process by which a health carrier determines the medical necessity or eligibility for coverage of a healthcare service before a covered person receives the healthcare service in order to provide coverage and reimbursement for the healthcare service; and
(2) “Telemedicine” means the same as defined in § 23-79-1601.
(b) When conducting prior authorization, whether for healthcare services provided through telemedicine or provided in person, a physician who possesses a current and unrestricted license to practice medicine in the State of Arkansas shall make all adverse determinations for healthcare services, medications, or equipment prescribed by a physician.
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-86-123
Stored review status: Historical 2020-11-06 source release; later amendments not reconciled; machine-extracted, not independently legally reviewed; source heading status: text_in_historical_source. A text match is a research starting point; applicability is not established.
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Record provenance
Stable record: arkansas_code:legal_authorities:23-86-123
Source file: gov.ar.code.title.23.odt
Pages: Not recorded – Not recorded
Passage SHA-256: 0729f9c9813a10645d51d60c28573784cd17f8c467057d761c12f33fe3301a01
Source location: content.xml paragraph 52016
Stored source content
23-86-123. Prior authorization by physician — Definitions.
(a) As used in this section:
(1) “Prior authorization” means the process by which a health carrier determines the medical necessity or eligibility for coverage of a healthcare service before a covered person receives the healthcare service in order to provide coverage and reimbursement for the healthcare service; and
(2) “Telemedicine” means the same as defined in § 23-79-1601.
(b) When conducting prior authorization, whether for healthcare services provided through telemedicine or provided in person, a physician who possesses a current and unrestricted license to practice medicine in the State of Arkansas shall make all adverse determinations for healthcare services, medications, or equipment prescribed by a physician.
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Arkansas Code — all titles (historical 2020) · legal_authorities
23-79-1601. Definitions.
As used in this subchapter:
(1) “Distant site” means the location of the healthcare professional delivering healthcare services through telemedicine at the time the services are provided;
(2)(A) “Health benefit plan” means:
(i) An individual, blanket, or group plan, policy, or contract for healthcare services issued or delivered by an insurer, health maintenance organization, hospital medical service corporation, or self-insured governmental or church plan in this state; and
(ii) Any health benefit program receiving state or federal appropriations from the State of Arkansas, including the Arkansas Medicaid Program, the Health Care Independence Program [expired], commonly referred to as the “Private Option”, and the Arkansas Works Program, or any successor program.
(B) “Health benefit plan” includes:
(i) Indemnity and managed care plans; and
(ii) Nonfederal governmental plans as defined in 29 U.S.C. § 1002(32), as it existed on January 1, 2015.
(C) “Health benefit plan” does not include:
(i) Disability income plans;
(ii) Credit insurance plans;
(iii) Insurance coverage issued as a supplement to liability insurance;
(iv) Medical payments under automobile or homeowners insurance plans;
(v) Health benefit plans provided under Arkansas Constitution, Article 5, § 32, the Workers' Compensation Law, § 11-9-101 et seq., or the Public Employee Workers' Compensation Act, § 21-5-601 et seq.;
(vi) Plans that provide only indemnity for hospital confinement;
(vii) Accident-only plans;
(viii) Specified disease plans; or
(ix) Long-term-care-only plans;
(3) “Healthcare professional” means a person who is licensed, certified, or otherwise authorized by the laws of this state to administer health care in the ordinary course of t
Source: Arkansas Code — historical release 78 (November 6, 2020) · 23-79-1601
Stored review status: Historical 2020-11-06 source release; later amendments not reconciled; machine-extracted, not independently legally reviewed; source heading status: text_in_historical_source. The source passage cites 23-79-1601. This identifies an authority to review, not proof of applicability.