Arkansas Prior Authorization Laws for Payers & PBMs
Arkansas is one of the most progressive states when it comes to prior authorization (PA) reform. Through legislation like AR Code § 23-99-11 and the recently passed HB 1271 (2023), the state has implemented stringent timelines, clinical transparency mandates, and even introduced “gold carding” to reduce administrative burden.
May 14, 2025
Stay Ahead of AR Code § 23-99-11 with Banjo Health’s Automation-First Platform
Arkansas is one of the most progressive states when it comes to prior authorization (PA) reform. Through legislation like AR Code § 23-99-11 and the recently passed HB 1271 (2023), the state has implemented stringent timelines, clinical transparency mandates, and even introduced “gold carding” to reduce administrative burden.
For payers and PBMs, the message is clear: your PA processes must be fast, fair, and transparent—or face significant compliance risk.
That’s where Banjo Health comes in.
⏱ PA Timelines in Arkansas
Arkansas law requires strict adherence to turnaround times based on request type:
● Non-Urgent Prior Authorization: Must be reviewed and a determination made within 2 business days
● Urgent or Emergency Requests: Must be reviewed and responded to within 1 business day
Banjo Health’s automation ensures real-time triage, decision routing, and tracking—so every request is resolved well within Arkansas’ legal limits.
⚡ The “Gold Card” Provision (HB 1271)
A standout feature of Arkansas’s PA law is the introduction of “Gold Carding” for providers:
● Providers with a 90% approval rate over 6 months may be exempt from PA requirements for certain services
● Payers must track performance data and automatically apply exemptions where applicable
Banjo Health’s analytics engine automatically tracks provider approval patterns and flags eligibility for Gold Card exemptions—reducing unnecessary PAs and making compliance automatic.
🧾 ePA and Submission Requirements
Arkansas encourages the use of electronic prior authorization (ePA) platforms and mandates the use of standardized forms for both medical and pharmacy requests.
Banjo supports:
✅NCPDP SCRIPT standard for ePA
✅ Customizable web-based intake forms
✅ Secure provider portals with real-time status updates
This ensures fast, accurate submissions and fewer incomplete or bounced-back requests.
📋 Clinical Criteria and Transparency Requirements
Under AR Code § 23-99-11, payers must:
● Publish written clinical criteria for PA decisions
● Make those criteria publicly available online
● Ensure decisions are based on evidence-based medicine
Banjo Health embeds these criteria into its automated rules engine—so every decision is backed by transparent, documented standards and shared with providers on demand.
👨⚕️ Clinical Reviewers & Appeals
When a request is denied, Arkansas law requires that:
● The denial be reviewed by a licensed physician
● The reviewer must be in a similar specialty to the requesting provider
● Contact information for the reviewer must be provided for appeals
Banjo Health automates peer-matching and includes reviewer contact details directly in provider-facing notifications—streamlining the appeal process and improving provider satisfaction.
✅ Why Arkansas Payers & PBMs Choose Banjo
Compliance with Arkansas law means hitting fast timelines, reducing friction, and tracking exemption eligibility. Banjo Health simplifies every part of the process:
✔️ Automated compliance with 1- and 2-day review windows
✔️ Gold Card tracking and exemption logic
✔️ Embedded clinical criteria for transparent decisioning
✔️ Integrated provider communications and audit logs
✔️ Full support for Arkansas-specific workflows
This blog is for informational purposes only and does not constitute legal, regulatory, or professional advice.