Preauthorization Services reviews
and addresses inpatient vs. outpatient setting, appropriateness of surgical procedure, and inpatient length of stay.
Preauthorization Services can also be utilized for diagnostic testing and ancillary services. Preauthorization reviews are completed in an expedient manner consistent with certified utilization review standards.
Preauthorization for
Arkansas workers’ compensation
The Arkansas Workers’ Compensation Commission (AWCC) requires preauthorization for certain procedures. Rules 30 and 33 enable payers to conduct pre-treatment reviews of proposed inpatient and, within specific parameters, outpatient procedures to determine if treatment and length of stay are appropriate. Rule 33 further requires a “medical peer review program” as part of the quality assurance program of an AWCC certified MCO.
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Following the guidelines for preauthorization, only an Arkansas-certified utilization
review (UR) entity can determine if a denial decision is appropriate for payment of any type of healthcare service or treatment resulting from a utilization review. Systemedic holds Arkansas UR certification and can meet this requirement for you.
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Guidelines for Preauthorization
The following require preauthorization service for workers’ compensation in Arkansas:
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Inpatient care (non-emergency)
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Transfers between facilities
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Outpatient facility services exceeding $1,000 billed by a provider for a single date of service
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Most outpatient surgeries
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Most MRIs
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MR arthrograms (MRI after arthrogram)
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Myelograms
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Epidural steroid injections
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The following do not require preauthorization service for workers’ compensation in Arkansas but can be reviewed for appropriateness:
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Physical therapy
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Occupational therapy
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Home health visits
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Durable medical equipment (DME) and supplies
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Bone scans
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Arthrograms
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CT scans
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Ultrasounds
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EMG/NCV studies
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What Our Customers Have To Say
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Senior Vice-President and
Claims Manager of a local LLC