§ 23-79-158. Denials of dental claims

AR Code § 23-79-158 (2018) (N/A)
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(a)

(1) As used in this section, "insurer" means an insurance company, a health maintenance organization, a hospital and medical service corporation, or a self-insured health plan for employees of a governmental entity that provides dental benefits.

(2) As used in this section, "insurer" includes an outside review entity that contracts with an insurance company, a health maintenance organization, a hospital and medical service corporation, or a self-insured health plan for employees of a governmental entity that provides dental benefits.

(b) A denial of all or part of a dental claim based upon medical necessity shall be made by a dentist licensed in the United States who is a graduate of a Commission on Dental Accreditation accredited program.

(c) To facilitate expeditious resolution, the insurer shall provide, upon request, a written communication to the treating dentist with the name, state where licensed, license number, and direct telephone number of the reviewing dentist.