Okla. Stat. tit. 36, § 36-6971

A. As used in this section:

1. “Health benefit plan” means a plan as defined pursuant to

Section 6060.4 of Title 36 of the Oklahoma Statutes;

2. “Health care facility” means a facility as defined pursuant

to Section 1-725.2 of Title 63 of the Oklahoma Statutes;

3. “Health care professional” means a professional as defined

pursuant to Section 6802 of Title 36 of the Oklahoma Statutes;

4. “Hospital” means a hospital as defined pursuant to Section

1-701 of Title 63 of the Oklahoma Statutes; and

5. “Provider” means a health care provider as defined pursuant

to Section 6571 of Title 36 of the Oklahoma Statutes.

B. Any insurer of a health benefit plan that is offered,

issued, or renewed in this state on or after the effective date of

this act shall publish an electronic provider directory for each of

its network plans, to be updated every sixty (60) days. The insurer

shall make clear the provider directory that applies to each network

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plan as marketed and issued in this state. The electronic directory

shall be published on an easily accessible website in a

standardized, downloadable, and searchable format. The electronic

directory shall include the following information:

1. For health care professionals:

a. name,

b. contact information, including a website address,

physical address, and phone number, and

c. specialty, if applicable;

2. For hospitals:

a. hospital name,

b. hospital type, including, but not limited to, acute,

rehabilitation, children’s, or cancer,

c. participating hospital location,

d. hospital accreditation status,

e. customer service telephone number, and

f. website address; and

3. For health care facilities other than hospitals:

a. facility name,

b. facility type,

c. types of services performed,

d. participating facility location or locations,

e. customer service telephone number, and

f. website address.

C. Any insurer of a health benefit plan that publishes a

provider directory pursuant to this section shall ensure that the

general public is able to view all of the current providers for a

network plan, through a clearly identifiable hyperlink or website

tab, without requiring any person to create or sign into an account

or submit a policy or contract number.

D. For each network plan published, an insurer of a health

benefit plan shall include in plain language the following

information:

1. A description of the criteria used to build its provider

network; and

2. If applicable:

a. a description of the criteria used to tier providers,

b. how the plan designates the different provider tiers

or levels, including, but not limited to, by name,

symbols, or grouping, in the network and for each

specific provider in the network, which tier each is

placed for an insured or a prospective insured to be

able to identify the provider tier, and

c. a notice that authorization or referral may be

required to access some providers.

E. 1. Provider directories, whether in electronic or, if

offered, print format, shall be accessible to individuals with

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disabilities and individuals with limited English proficiency as

defined in 45 C.F.R. Sections 92.201 and 155.205.

2. The plan shall include a disclosure in any print directory

issued under this subsection that the information in the directory

is accurate as of the date of printing and that an insured or

prospective insured should consult the electronic provider directory

on the website of the plan or call the listed customer service

telephone number to obtain current provider directory information.

F. 1. The health benefit plan shall include in both its online

and print directories, if offered, a clearly identifiable telephone

number, email address, or link to a webpage which an insured or the

general public may use to report to the plan inaccurate information
n the website of the plan or call the listed customer service

telephone number to obtain current provider directory information.

F. 1. The health benefit plan shall include in both its online

and print directories, if offered, a clearly identifiable telephone

number, email address, or link to a webpage which an insured or the

general public may use to report to the plan inaccurate information

listed in the provider directory. Whenever a plan receives a

report, it shall promptly investigate the report and, not later than

two (2) days following the receipt of such report, either verify the

accuracy of the information or update the information.

2. A plan shall take appropriate steps to ensure the accuracy

of the information concerning each provider listed in the provider

directory. The plan shall contact providers as necessary to ensure

that the information provided in the directory is up to date.

3. The plan shall, at least annually, audit its provider

directories for accuracy. The audit should be focused on the top

four utilized specialties to include at least one specialty related

to mental health. Alternatively, plans may audit based on a

reasonable sample size of providers, as long as the sample size

includes behavioral health providers. The plan shall retain

documentation of any audit conducted under this paragraph to be made

available to the Insurance Commissioner. Based on the results of a

given audit, the plan shall verify and attest to the accuracy of the

information or update the information.

G. An insurer of a health benefit plan shall, by certified

mail, return receipt requested, or by electronic mail, read receipt

requested, notify any provider of its removal from the network if

the provider has not submitted claims to the plan or otherwise

communicated intent to continue participation in the plan network

within a twelve-month period. If the provisions of the contract

entered between the plan and the provider provides notice terms, the

notice shall be provided in accordance with such terms. If the plan

does not receive a response from the provider within thirty (30)

days of such notification, the plan shall remove the provider from

the network.

H. In accordance with any timeframes and requirements that may

be established by the Commissioner, an insurer of a health benefit

plan shall report to the Commissioner the following:

1. The number of reports received pursuant to subsection F of

this section, the timeliness of the response from the plan, and the

corrective action or actions taken; and

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2. All auditing reports conducted by the plan pursuant to

subsection F of this section.

I. If an insured reasonably relies upon materially inaccurate

information contained in a provider directory of a plan, the

Commissioner may require the plan to provide coverage for all

covered health care services provided to the insured and to

reimburse the insured for any amount that he or she would have to

pay if the services would have been delivered by an in-network

provider under the network plan. Provided, the Commissioner shall

take into consideration that health benefit plan insurers are

relying on health care providers to report changes to their

information prior to requiring any reimbursement to an insured. In

the event that the Commissioner finds that the provider has not

provided updated information for the network directory of the

insurer of a health benefit plan, the Commissioner may require that

the provider be reimbursed at the assignment of benefits rate for

the service if it were conducted in-network. Prior to requiring

reimbursement under this subsection, the Commissioner shall conclude

that the services received by the plan were covered services under

the insured’s network plan. If the services satisfy requirements of

this subsection, a plan shall not deny reimbursement to an insured
rovider be reimbursed at the assignment of benefits rate for

the service if it were conducted in-network. Prior to requiring

reimbursement under this subsection, the Commissioner shall conclude

that the services received by the plan were covered services under

the insured’s network plan. If the services satisfy requirements of

this subsection, a plan shall not deny reimbursement to an insured

based on the provider of the services being out-of-network.

J. The Commissioner may promulgate rules to effectuate the

provisions of this section.