The bill amends the liability of third parties, including health insurers, to the Department of Human Services regarding Arkansas Medicaid program claims. It establishes prompt payment guidelines and time periods for waivers and final resolutions of claims. Notably, the bill clarifies that a denial of a claim cannot be based on a lack of prior authorization if the Department has authorized the item or service. Additionally, it mandates that third parties must respond to inquiries about claims within sixty business days after receiving the necessary documentation from the Medicaid recipient.

Key changes in the bill include the insertion of provisions that require health insurers or third parties to accept Medicaid's right of recovery and to process claims as if they had been properly billed at the point of sale. The bill also removes the previous stipulation that allowed claims to be denied based on the failure to present proper documentation of coverage at the point of sale or the date of submission, provided the claim is submitted within three years of the service date. These amendments aim to streamline the claims process and ensure timely payments to Medicaid recipients.

Statutes affected:
SB 348: 20-77-306(d)
Act 369: 20-77-306(d)