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Utilization Review

Utilization Review

Utilization Review monitors the quality of service delivered by Arkansas Medicaid health care providers. It identifies and investigates possible fraudulent and abusive billing practices, and it recovers funds from providers who have received state funds through such practices.

Through random-sample questionnaires to beneficiaries, it assures that individuals actually received the services for which Arkansas Medicaid has paid. Questionable responses to the questionnaires are referred to the Field Audit Section.

Utilization Review also provides prior authorization for medical services such as prosthetics, hearing aids, hyperalimentation services, and out-of-state transportation, and it monitors the primary care physicians program.