Okla. Stat. tit. 74, § 74-1328
This is the official text of Okla. Stat. tit. 74, § 74-1328, part of Oklahoma’s Stat. tit. 74, — part of the compiled statutory law of Oklahoma, published by the state as "Stat. tit. 74,." Browse the sections below, each linked to its official government source.
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Reimbursement of claims within certain time period
Official statutory text
A. The contracted claims administrator for the Oklahoma Health
Care Authority shall reimburse all clean claims of an enrollee, an
assignee of the enrollee, or a health care provider within forty-
five (45) calendar days after receipt of the claim by the entity.
B. As used in this section, "clean claim" means a claim that
has no defect or impropriety, including a lack of any required
substantiating documentation, or particular circumstance requiring
special treatment that impedes prompt payment.
C. 1. If a claim or any portion of a claim is determined to
have defects or improprieties, including a lack of any required
substantiating documentation, or a particular circumstance requiring
special treatment, the enrollee, assignee of the enrollee, or health
care provider shall be notified in writing within thirty (30)
calendar days after receipt of the claim by the contracted claims
administrator for the Authority. The written notice shall specify
the portion of the claim that is causing a delay in processing and
explain any additional information or corrections needed. Failure
of the Authority's claims administrator to provide the enrollee,
assignee of the enrollee, or health care provider with such notice
shall constitute prima facie evidence that the claim will be paid in
accordance with the terms of the health benefit claims
administration contract.
2. The portion of the claim that is accurate shall be paid
within forty-five (45) calendar days after receipt of the claim by
the claims administrator for the Authority.
D. Upon receipt of the additional information or corrections
which led to the claim's being delayed and a determination that the
Oklahoma Statutes - Title 74. State Government Page 829
information is accurate, the claims administrator for the Authority
shall either pay or deny the claim or a portion of the claim within
forty-five (45) calendar days.
E. Payment shall be considered made on:
1. The date a draft or other valid instrument which is
equivalent to the amount of the payment is placed in the United
States mail in a properly addressed, postpaid envelope; or
2. If not so posted, the date of delivery.
F. An overdue payment shall bear simple interest at the rate of
ten percent (10%) per year.
G. In the event litigation should ensue based upon such a
claim, the prevailing party shall be entitled to recover a
reasonable attorney fee to be set by the court and taxed as costs
against the party or parties who do not prevail.
Care Authority shall reimburse all clean claims of an enrollee, an
assignee of the enrollee, or a health care provider within forty-
five (45) calendar days after receipt of the claim by the entity.
B. As used in this section, "clean claim" means a claim that
has no defect or impropriety, including a lack of any required
substantiating documentation, or particular circumstance requiring
special treatment that impedes prompt payment.
C. 1. If a claim or any portion of a claim is determined to
have defects or improprieties, including a lack of any required
substantiating documentation, or a particular circumstance requiring
special treatment, the enrollee, assignee of the enrollee, or health
care provider shall be notified in writing within thirty (30)
calendar days after receipt of the claim by the contracted claims
administrator for the Authority. The written notice shall specify
the portion of the claim that is causing a delay in processing and
explain any additional information or corrections needed. Failure
of the Authority's claims administrator to provide the enrollee,
assignee of the enrollee, or health care provider with such notice
shall constitute prima facie evidence that the claim will be paid in
accordance with the terms of the health benefit claims
administration contract.
2. The portion of the claim that is accurate shall be paid
within forty-five (45) calendar days after receipt of the claim by
the claims administrator for the Authority.
D. Upon receipt of the additional information or corrections
which led to the claim's being delayed and a determination that the
Oklahoma Statutes - Title 74. State Government Page 829
information is accurate, the claims administrator for the Authority
shall either pay or deny the claim or a portion of the claim within
forty-five (45) calendar days.
E. Payment shall be considered made on:
1. The date a draft or other valid instrument which is
equivalent to the amount of the payment is placed in the United
States mail in a properly addressed, postpaid envelope; or
2. If not so posted, the date of delivery.
F. An overdue payment shall bear simple interest at the rate of
ten percent (10%) per year.
G. In the event litigation should ensue based upon such a
claim, the prevailing party shall be entitled to recover a
reasonable attorney fee to be set by the court and taxed as costs
against the party or parties who do not prevail.
Status: in_force · Read it on the official government site
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