Okla. Stat. tit. 36, § 36-6570.6
This is the official text of Okla. Stat. tit. 36, § 36-6570.6, 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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Time frame to make prior authorization or adverse
Official statutory text
determination.
A. If a utilization review entity requires prior authorization
of a health care service, the utilization review entity must make a
prior authorization or adverse determination and notify the enrollee
and the enrollee's health care provider of the prior authorization
or adverse determination in accordance with the time frames set
forth below:
Oklahoma Statutes - Title 36. Insurance Page 1312
1. For purposes of approving prior authorization for urgent
health care services, within seventy-two (72) hours of obtaining all
necessary information to make the prior authorization or adverse
determination; or
2. For purposes of approving prior authorization for non-urgent
health care services, within seven (7) days of obtaining all
necessary information to make the prior authorization or adverse
determination.
For purposes of this section, "necessary information" includes,
but is not limited to, the results of any face-to-face clinical
evaluation or second opinion that may be required.
B. For those health care providers that submit all necessary
information through the utilization review entity's authorized prior
authorization system, health care services are deemed authorized if
a utilization review entity fails to comply with the deadlines set
forth in this section.
C. In the notification to the health care provider that a prior
authorization has been approved, the utilization review entity shall
include in such notification the duration of the prior authorization
or the date by which the prior authorization will expire.
A. If a utilization review entity requires prior authorization
of a health care service, the utilization review entity must make a
prior authorization or adverse determination and notify the enrollee
and the enrollee's health care provider of the prior authorization
or adverse determination in accordance with the time frames set
forth below:
Oklahoma Statutes - Title 36. Insurance Page 1312
1. For purposes of approving prior authorization for urgent
health care services, within seventy-two (72) hours of obtaining all
necessary information to make the prior authorization or adverse
determination; or
2. For purposes of approving prior authorization for non-urgent
health care services, within seven (7) days of obtaining all
necessary information to make the prior authorization or adverse
determination.
For purposes of this section, "necessary information" includes,
but is not limited to, the results of any face-to-face clinical
evaluation or second opinion that may be required.
B. For those health care providers that submit all necessary
information through the utilization review entity's authorized prior
authorization system, health care services are deemed authorized if
a utilization review entity fails to comply with the deadlines set
forth in this section.
C. In the notification to the health care provider that a prior
authorization has been approved, the utilization review entity shall
include in such notification the duration of the prior authorization
or the date by which the prior authorization will expire.
Status: in_force · Read it on the official government site
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