§ 20-9-902 - Definitions. - Arkansas Statutes

20-9-902. Definitions.

As used in this subchapter:

(1) "Board" means the State Board of Health;

(2) "Certificate" means a certificate of registration granted by the State Board of Health to a private review agent;

(3) (A) "Private review agent" means a nonhospital-affiliated person or entity performing utilization review on behalf of:

(i) An employer of employees in the State of Arkansas; or

(ii) A third party that provides or administers hospital and medical benefits to citizens of this state, including:

(a) A health maintenance organization issued a certificate of authority under and by virtue of the laws of the State of Arkansas; and

(b) A health insurer, nonprofit health service plan, health insurance service organization, or preferred provider organization or other entity offering health insurance policies, contracts, or benefits in this state.

(B) "Private review agent" does not include automobile, homeowner, or casualty and commercial liability insurers or their employees, agents, or contractors;

(4) "Utilization review" means a system for review which reviews the appropriate and efficient allocation of hospital resources and medical services given or proposed to be given to a patient or group of patients; and

(5) "Utilization review plan" means a description of the utilization review procedures of a private review agent.