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Specific Services Need Pre-Certification
The Employee Benefit Division (EBD) has contracted with a third-party vendor, American Health
Holding (AHH), not affiliated with Health Advantage,
effective Oct. 1, 2007, for the Arkansas State and Public School employees, to provide utilization
management services that include pre-certification, pre-determination and concurrent review. Services
that require pre-certification from AHH include but are not limited to: inpatient admissions,
transplants, therapy services, high tech radiology procedures, some out patient surgeries, etc. Refer to the AHH - Services That Require Pre-certification (27 KB PDF)
on the HA Web site for the specific services that require pre-certification. Please contact, or have your physician contact, AHH
at 1-800-592-0358 for pre-certification for your patient receiving these types of services. If the
Arkansas State or Public School member is Medicare Primary pre-certification by AHH is not
required.
Appeals
If a claim for benefits is denied either in whole or in part, you may request a review of a
denial of benefits or any claim or portion of a claim by sending a written appeal to the plan
administrator, Employee Benefits Division, within the number of days as identified within your
Summary Plan Description. Your appeal should include your name, identification number, and
reference to the denied claim. In preparing your request for review, you or your authorized
representative have the right to examine documents relevant to your claim. You or your authorized
representative may submit, with your request for review, any additional information relevant to
your claim and may also submit issues and comments in writing. You will receive a final decision
in writing within the number of days specified in your Summary Plan Description. If the appeal is
related to a service that required pre-certification from AHH, call American Health Holding
at 1-800-592-0358.
Case Management
For case management and health education services, call the Employee Benefit Division (EBD)
at 1-877-815-1017 or 501-682-9656.
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