A. Prior Authorization of Non-Urgent Healthcare Services (A.C.A. 23-99-1105)
OrthoNet acting on behalf of the Health Plan must make an authorization or non-authorization determination and notify the subscriber (member) and provider of the
determination/decision within 2 business days of obtaining all the information needed to make the determination.
B. Prior Authorization of Urgent Healthcare Service (A.C.A. 23-99-1106)
OrthoNet acting on behalf of the Health Plan must make an expedited authorization or adverse determination on an urgent request and notify the subscriber (member)
and provider of the determination no later than 1 business day after receipt of all information needed to complete the review.
C. Retrospective Denial (A.C.A 23-99-1108)
1. OrthoNet may not revoke (cancel), limit, condition, or restrict an authorization for a period of 45 business days from the date the provider received the authorization.
2. Any correspondence, contact, or other activity by OrthoNet that disclaims, denies, or attempts to disclaim, or attempts to deny payment for services that have been authorized
within the 45-day period is void.
D. Written Clinical Criteria
Written clinical criteria can be found on at the following link: Clinical Criteria.
Per A.C.A. 23-99-1104 Statistics are made readily available regarding prior authorization approvals and denials.