Okla. Stat. tit. 36, § 36-6554: Exemptions - Review of patients eligible under Social

Security - In-house utilization review.

A. The Insurance Commissioner shall waive the requirements of

the Hospital and Medical Services Utilization Review Act for the

activities of a private review agent in connection with a contract

with the federal or state government for utilization review of

patients eligible for hospital and medical services under the Social

Security Act.

B. No certificate is required for those private review agents

conducting general in-house utilization review for hospitals, home

health agencies, preferred provider organizations, or other managed

care entities, clinics, private offices or any other health facility

or entity, so long as the review does not result in the approval or

denial of payment for hospital or medical services for a particular

case. Such general in-house utilization review shall be exempt from

all provisions of the Hospital and Medical Services Utilization

Review Act.