Okla. Stat. tit. 36, § 36-6570.3
This is the official text of Okla. Stat. tit. 36, § 36-6570.3, 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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Adverse determinations to be made by physician or
Official statutory text
licensed mental health professional.
A utilization review entity shall ensure that all adverse
determinations are made by a physician or licensed mental health
professional. The physician or licensed mental health professional
shall:
1. Possess a current and valid nonrestricted license in any
United States jurisdiction;
2. Have the appropriate training, knowledge, or expertise to
apply appropriate clinical guidelines to the health care service
being requested; and
3. Make the adverse determination under the clinical direction
of one of the utilization review entity's medical directors who is
responsible for the provision of reviewing health care services to
enrollees of Oklahoma. All such medical directors must be
physicians licensed in any United States jurisdiction.
A utilization review entity shall ensure that all adverse
determinations are made by a physician or licensed mental health
professional. The physician or licensed mental health professional
shall:
1. Possess a current and valid nonrestricted license in any
United States jurisdiction;
2. Have the appropriate training, knowledge, or expertise to
apply appropriate clinical guidelines to the health care service
being requested; and
3. Make the adverse determination under the clinical direction
of one of the utilization review entity's medical directors who is
responsible for the provision of reviewing health care services to
enrollees of Oklahoma. All such medical directors must be
physicians licensed in any United States jurisdiction.
Status: in_force · Read it on the official government site
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