August 1, 2017 (pre-NSA)
Strengthened and aligned with NSA on January 1, 2022

Arkansas enacted early surprise billing protections aimed at preventing patients from receiving excessive out-of-network (OON) charges, especially in emergency situations. Following the passage of the federal No Surprises Act (NSA), Arkansas integrated additional requirements to ensure alignment with federal standards.

Arkansas provides strong patient protections for unexpected OON services. Under state law:

• Patients cannot be billed more than in-network cost-sharing for emergency care or for OON services received at an in-network facility when they had no reasonable opportunity to choose a participating provider.
• Providers must submit claims directly to the insurer, not the patient.
• Insurers must pay providers a reasonable, market-based amount for covered OON services.

Although Arkansas does not use an APCD-based benchmark nor a fixed fee schedule, the state requires insurers to use:

• A “usual, customary, and reasonable” (UCR) methodology
• Rates consistent with generally accepted industry standards

Once the NSA took effect, most commercial OON pricing shifted to the federal QPA-based framework for applicable claims.

Arkansas does not operate its own state-run arbitration system for resolving OON payment disputes between providers and insurers.

As a result:

• Arkansas does not have a Specified State Law (SSL) for OON rate determination.
• There is no Arkansas-based IDR mechanism.
• All eligible disputes default to the federal NSA IDR system.

This applies to emergency care, certain non-emergency services at in-network facilities, and other claim categories defined under federal law.

Arkansas follows the federal procedural requirements:

• The insurer must issue an initial payment or denial.
• Providers and carriers have 30 days to negotiate.
• If no agreement is reached, either party may file a case in the federal IDR portal.

State law does not add a separate negotiation or timing requirement.

Because Arkansas defaults to the federal NSA system, the IDR entity must evaluate the federal criteria, including:

• Qualified Payment Amount (QPA) — the primary factor
• Provider training, experience, and patient acuity
• Contracting history and prior in-network rates (last four years)
• Market share of provider and insurer
• Efforts to enter or maintain network agreement
• Complexity, case severity, and facility type

Arkansas law does not introduce additional arbitration considerations.

Arkansas balances billing protections and insurance regulations are found in:

• Arkansas Code § 23-99-1201 through § 23-99-1206 (Patient billing protections)
• Arkansas Insurance Department regulations
• Federal NSA requirements via 45 CFR 149.510 and 149.520

These statutes prohibit inappropriate balance billing but do not create a state-defined OON payment methodology.

CMS has determined that Arkansas does not maintain a Specified State Law (SSL) governing OON payment rates.

• Insured commercial health plans
• Individual insurance policies
• Group insurance coverage
• Self-funded ERISA plans (unless electing another SSL, which is extremely rare)

• The QPA is the controlling benchmark for OON claim payments.
• All qualifying disputes proceed through federal IDR, not a state system.
• Arkansas insurers must follow NSA timelines for payment, negotiation, and dispute resolution.
• Patients are protected under both Arkansas law and the federal NSA.

Arkansas’s state law enhances patient protections but does not alter federal OON payment procedures.