Okla. Stat. tit. 36, § 36-6570.8
This is the official text of Okla. Stat. tit. 36, § 36-6570.8, 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 in which prior authorization may not be
Official statutory text
altered — Contracted payment rate requirement and exceptions.
A. A health benefit plan may not revoke, limit, condition, or
restrict a prior authorization if care is provided within forty-five
(45) business days from the date the health care provider received
Oklahoma Statutes - Title 36. Insurance Page 1313
the prior authorization unless the enrollee was no longer eligible
for care on the day care was provided.
B. A health benefit plan must pay a contracted health care
provider at the contracted payment rate for a health care service
provided by the health care provider per a prior authorization,
unless:
1. The health care provider knowingly and materially
misrepresented the health care service in the prior authorization
request with the specific intent to deceive and obtain an unlawful
payment from a utilization review entity;
2. The health care service was no longer a covered benefit on
the day it was provided;
3. The health care provider was no longer contracted with the
patient's health benefit plan on the date the care was provided;
4. The health care provider failed to meet the utilization
review entity's timely filing requirements; or
5. The patient was no longer eligible for health care coverage
on the day the care was provided.
A. A health benefit plan may not revoke, limit, condition, or
restrict a prior authorization if care is provided within forty-five
(45) business days from the date the health care provider received
Oklahoma Statutes - Title 36. Insurance Page 1313
the prior authorization unless the enrollee was no longer eligible
for care on the day care was provided.
B. A health benefit plan must pay a contracted health care
provider at the contracted payment rate for a health care service
provided by the health care provider per a prior authorization,
unless:
1. The health care provider knowingly and materially
misrepresented the health care service in the prior authorization
request with the specific intent to deceive and obtain an unlawful
payment from a utilization review entity;
2. The health care service was no longer a covered benefit on
the day it was provided;
3. The health care provider was no longer contracted with the
patient's health benefit plan on the date the care was provided;
4. The health care provider failed to meet the utilization
review entity's timely filing requirements; or
5. The patient was no longer eligible for health care coverage
on the day the care was provided.
Status: in_force · Read it on the official government site
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