Utilization Review Licensing in Arkansas

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Utilization review licenses and certificates are typically issued for organizations conducting either medical or workers’ compensation reviews. This guide contains information about utilization review in Arkansas. For assistance with licensing, please contact us to learn about our software and managed license services.

Arkansas Private Review Agent Certification

Type of Review:

Medical or Workers' Compensation Utilization Review

Agency:Arkansas Department of Health
Law:

AR Code § 20-9-901 et seq.

Notes:

Only private review agents, as defined by AR Code § 20-9-202, are required to register. Additional exemptions are noted in AR Code § 20-9-904.

Initial Registration

Agency:Arkansas Department of Health
Form:

Utilization Review Application

Agency fee:

$2,500

Notarize:Required

Registration Renewal

Agency:Arkansas Department of Health
Form:

Utilization Review Application (Renewal)

Agency fee:

$2,500

Due:

Biennially on the anniversary of certification.

Adverse Determination - When a health care plan or utilization review program decides that a medical treatment or service is not necessary.

Concurrent Review - Utilization review that is conducted during a patient’s course of treatment.

External Review - When an independent review organization is consulted to appeal an insurance company’s adverse determination.

Independent Review Organization (IRO) - Unbiased third-parties that conduct utilization review.

Prospective Review - Utilization review that occurs prior to treatment.

Retrospective Review - Utilization review that occurs after treatment and often after payment.

Utilization Review - A system for evaluating the medical necessity, efficiency, and appropriateness of medical services.

Utilization Review Agent (URA) - An entity that conducts utilization review.

Utilization Review Plan - A document of the procedures used during utilization review.

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