Okla. Stat. tit. 36, § 36-6553
This is the official text of Okla. Stat. tit. 36, § 36-6553, part of Oklahoma’s Stat. tit. 36, — part of the compiled statutory law of Oklahoma, published by the state as "Stat. tit. 36,." Browse the sections below, each linked to its official government source.
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Private review agents - Certification required -
Official statutory text
Exemptions.
A. A private review agent who approves or denies payment or who
recommends approval or denial of payment for hospital or medical
services or whose review results in approval or denial of payment
for hospital or medical services on a case-by-case basis shall not
conduct utilization review in this state unless the Insurance
Commissioner has granted the private review agent a certificate.
B. Except as provided in Section 9 of this act, the Hospital
and Medical Services Utilization Review Act shall not apply to any
insurance company or not-for-profit hospital service and medical
indemnity plan licensed by the Commissioner to transact insurance in
this state. If the insurer contracts outside the company for any or
all utilization review services, the entity with whom the insurance
company contracts shall be subject to all of the provisions of the
Hospital and Medical Services Utilization Review Act.
C. The State and Education Employees Group Insurance Board
shall be exempt from the provisions of the Hospital and Medical
Services Utilization Review Act and regulated accordingly as
provided for in the State and Education Employees Group Insurance
Act. In addition, the Board shall comply with the provisions of
Section 17 of this act. If the State and Education Employees Group
Insurance Board contracts for utilization review services instead of
having utilization review services be performed by employees of the
Board, the entity with whom the Board contracts shall be subject to
all of the provisions of the Hospital and Medical Services
Utilization Review Act.
A. A private review agent who approves or denies payment or who
recommends approval or denial of payment for hospital or medical
services or whose review results in approval or denial of payment
for hospital or medical services on a case-by-case basis shall not
conduct utilization review in this state unless the Insurance
Commissioner has granted the private review agent a certificate.
B. Except as provided in Section 9 of this act, the Hospital
and Medical Services Utilization Review Act shall not apply to any
insurance company or not-for-profit hospital service and medical
indemnity plan licensed by the Commissioner to transact insurance in
this state. If the insurer contracts outside the company for any or
all utilization review services, the entity with whom the insurance
company contracts shall be subject to all of the provisions of the
Hospital and Medical Services Utilization Review Act.
C. The State and Education Employees Group Insurance Board
shall be exempt from the provisions of the Hospital and Medical
Services Utilization Review Act and regulated accordingly as
provided for in the State and Education Employees Group Insurance
Act. In addition, the Board shall comply with the provisions of
Section 17 of this act. If the State and Education Employees Group
Insurance Board contracts for utilization review services instead of
having utilization review services be performed by employees of the
Board, the entity with whom the Board contracts shall be subject to
all of the provisions of the Hospital and Medical Services
Utilization Review Act.
Status: in_force · Read it on the official government site
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