What is prior authorization?
Prior authorization (PA) means the insurer must approve certain care before it happens. If PA is denied, the service usually has not been provided yet—that is different from a claim denial after care.
For a plain-language overview for any state, see Prior authorizations. This page covers Arkansas only.
Confirm plan type: Arkansas: Start Here.
Arkansas PA deadlines
Arkansas's Prior Authorization Transparency Act (Ark. Code Title 23, Chapter 99, Subchapter 11) applies to utilization review entities—including many health insurers and their review vendors.
How fast must the plan decide?
After the plan has all information needed to decide:
- Non-urgent care: approve or deny within 2 business days (Ark. Code § 23-99-1105)
- Urgent care: within 1 business day (Ark. Code § 23-99-1106)
- Prescription drugs: many requests must be decided within 72 hours (per state law summaries and insurer rules—confirm on the denial notice)
If the plan misses the deadline
If the utilization review entity does not follow these rules, the requested services are generally deemed approved (Ark. Code § 23-99-1116). Document when the request was submitted and what the plan did or did not return.
After a PA denial (cancer and related diagnoses)
For hematology, oncology, and certain other conditions the Insurance Commissioner lists by rule, if PA is denied the patient or provider can appeal to the plan. The plan must decide within 4 business days after it has needed information (Ark. Code § 23-99-1105(c)).
Protections once PA is approved
- Plans generally cannot revoke PA for medical necessity without at least 3 business days notice before the scheduled service (Ark. Code § 23-99-1109)
- Plans generally cannot deny payment for a service that had valid PA, with limited exceptions (Ark. Code § 23-99-1109(c))
- Terminal illness: covered prescription pain medication PA cannot be denied (Ark. Code § 23-99-1108)
Adverse PA denials for medical necessity must be made by a qualified clinician; Arkansas-licensed physicians review many denials (Ark. Code § 23-99-1111).
Where to look up PA rules
Match tools to the exact plan on the ID card. Major 2026 Marketplace carriers include:
- Arkansas Blue Cross Blue Shield (USAble): arkansasbluecross.com
- Ambetter (Celtic): ambetterhealth.com
- QualChoice / QCA Health Plan: qualchoice.com
- UnitedHealthcare, Cigna, Oscar— use national portals tied to the member's card
Medicaid and ARHOME
Medicaid PA and service denials follow DHS rules, not Subchapter 11. Members and providers may request an administrative hearing—often within 30 calendar days of the notice (humanservices.arkansas.gov — file an appeal). ARHOME (Medicaid expansion through private Qualified Health Plans) has its own appeal path through the plan and DHS.
If PA is denied
- Get the denial in writing with the specific reason.
- Ask the treating clinician for records and a medical necessity letter.
- File an internal appeal using the denial instructions — Arkansas internal appeals.
- If care cannot wait, ask for expedited review.
Building a strong appeal packet has a checklist.
Urgent and emergency care
Emergency care: Plans cannot require PA for emergency services. After an emergency, the member or provider generally has at least 24 hours (or until the next business day after a weekend) to notify the plan. Post-stabilization care must be authorized within 60 minutes or it is deemed approved (Ark. Code § 23-99-1107).
For urgent (non-emergency) cases, use the 1-business-day PA rule and expedited appeal paths in internal appeals and expedited appeals on the Appeals Roadmap.