Okla. Stat. tit. 36, § 36-7302
This is the official text of Okla. Stat. tit. 36, § 36-7302, 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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Dental insurance plans - Contracting entity requirements
Official statutory text
A. As used in this section:
1. "Contracting entity" means any person or entity that is
engaged in the act of contracting with providers for the delivery of
dental services or the selling or assigning of dental plans to other
dental care entities;
2. "Identify" means providing in writing, by email or
otherwise, to the participating provider the name, address and
telephone number, to the extent possible, for any third party to
which the contracting entity has granted access to the dental
services of the participating provider;
3. "Network plan" means dental plans offered by a health
insurance issuer under which the financing and delivery of dental
services are provided in whole or in part through a defined set of
participating providers under contract with the health insurance
issuer;
4. "Participating provider" means a provider who, under a
contract with a contracting entity, has agreed to provide dental
services with an expectation of receiving payment, other than
Oklahoma Statutes - Title 36. Insurance Page 1503
coinsurance, copayments or deductibles, directly or indirectly, from
the contracting entity; and
5. "Provider" means any person licensed by the Board of
Dentistry pursuant to the provisions of Section 328.21 of Title 59
of the Oklahoma Statutes.
B. A contracting entity shall not sell, assign or otherwise
grant access to the dental services of a participating provider
under any health care contract unless expressly authorized by the
health care contract. The health care contract shall specifically
provide that one purpose of the contract is the selling, assigning
or giving the contracting entity rights to the services of the
participating provider, including network plans.
C. Upon entering a contract with a participating provider and
upon request by a participating provider, a contracting entity shall
properly identify any third party that has been granted access to
the dental services of the participating provider.
D. A contracting entity that sells, assigns or otherwise grants
access to the dental services of a participating provider shall
maintain an Internet website or a toll-free telephone number through
which the participating provider may obtain information which
identifies the insurance carrier to be used to reimburse the
participating provider for the covered dental services.
E. A contracting entity that sells, assigns or otherwise grants
access to a participating provider's dental services shall ensure
that an explanation of benefits or remittance advice furnished to
the participating provider that delivers dental services under the
health care contract identifies the contractual source of any
applicable discount.
F. All third parties that have contracted with a contracting
entity to purchase, be assigned or otherwise be granted access to
the participating provider's discounted rate shall comply with the
participating provider's contract, including all requirements to
encourage access to the participating provider, and pay the
participating provider pursuant to the rates of payment and
methodology set forth in that contract, unless otherwise agreed to
by a participating provider.
G. A contracting entity is deemed in compliance with this
section when the insured's identification card provides information
which identifies the insurance carrier to be used to reimburse the
participating provider for the covered dental services.
1. "Contracting entity" means any person or entity that is
engaged in the act of contracting with providers for the delivery of
dental services or the selling or assigning of dental plans to other
dental care entities;
2. "Identify" means providing in writing, by email or
otherwise, to the participating provider the name, address and
telephone number, to the extent possible, for any third party to
which the contracting entity has granted access to the dental
services of the participating provider;
3. "Network plan" means dental plans offered by a health
insurance issuer under which the financing and delivery of dental
services are provided in whole or in part through a defined set of
participating providers under contract with the health insurance
issuer;
4. "Participating provider" means a provider who, under a
contract with a contracting entity, has agreed to provide dental
services with an expectation of receiving payment, other than
Oklahoma Statutes - Title 36. Insurance Page 1503
coinsurance, copayments or deductibles, directly or indirectly, from
the contracting entity; and
5. "Provider" means any person licensed by the Board of
Dentistry pursuant to the provisions of Section 328.21 of Title 59
of the Oklahoma Statutes.
B. A contracting entity shall not sell, assign or otherwise
grant access to the dental services of a participating provider
under any health care contract unless expressly authorized by the
health care contract. The health care contract shall specifically
provide that one purpose of the contract is the selling, assigning
or giving the contracting entity rights to the services of the
participating provider, including network plans.
C. Upon entering a contract with a participating provider and
upon request by a participating provider, a contracting entity shall
properly identify any third party that has been granted access to
the dental services of the participating provider.
D. A contracting entity that sells, assigns or otherwise grants
access to the dental services of a participating provider shall
maintain an Internet website or a toll-free telephone number through
which the participating provider may obtain information which
identifies the insurance carrier to be used to reimburse the
participating provider for the covered dental services.
E. A contracting entity that sells, assigns or otherwise grants
access to a participating provider's dental services shall ensure
that an explanation of benefits or remittance advice furnished to
the participating provider that delivers dental services under the
health care contract identifies the contractual source of any
applicable discount.
F. All third parties that have contracted with a contracting
entity to purchase, be assigned or otherwise be granted access to
the participating provider's discounted rate shall comply with the
participating provider's contract, including all requirements to
encourage access to the participating provider, and pay the
participating provider pursuant to the rates of payment and
methodology set forth in that contract, unless otherwise agreed to
by a participating provider.
G. A contracting entity is deemed in compliance with this
section when the insured's identification card provides information
which identifies the insurance carrier to be used to reimburse the
participating provider for the covered dental services.
Status: in_force · Read it on the official government site
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