{"data":{"id":"us-ok/okla.-stat.-tit.-36-36-6552","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 36, § 36-6552","heading":"Definitions","body":"As used in the Hospital and Medical Services Utilization Review\n\nAct:\n\n1. \"Utilization review\" means a system for prospectively,\n\nconcurrently and retrospectively reviewing the appropriate and\n\nefficient allocation of hospital resources and medical services\n\ngiven or proposed to be given to a patient or group of patients. It\n\ndoes not include an insurer's normal claim review process to\n\ndetermine compliance with the specific terms and conditions of the\n\ninsurance policy;\n\n2. \"Private review agent\" means a person or entity who performs\n\nutilization review on behalf of:\n\na. an employer in this state, or\n\nb. a third party that provides or administers hospital\n\nand medical benefits to citizens of this state,\n\nincluding, but not limited to:\n\n(1) a health maintenance organization issued a\n\nlicense pursuant to Section 2501 et seq. of Title\n\n63 of the Oklahoma Statutes, unless the health\n\nmaintenance organization is federally regulated\n\nand licensed and has on file with the Insurance\n\nCommissioner a plan of utilization review carried\n\nout by health care professionals and providing\n\nfor complaint and appellate procedures for\n\nclaims, or\n\n(2) a health insurer, not-for-profit hospital service\n\nor medical plan, health insurance service\n\norganization, or preferred provider organization\n\nor other entity offering health insurance\n\npolicies, contracts or benefits in this state;\n\n3. \"Utilization review plan\" means a description of utilization\n\nreview procedures;\n\n4. \"Commissioner\" means the Insurance Commissioner;\n\n5. \"Certificate\" means a certificate of registration granted by\n\nthe Insurance Commissioner to a private review agent; and\n\n6. \"Health care provider\" means any person, firm, corporation\n\nor other legal entity that is licensed, certified, or otherwise\n\nauthorized by the laws of this state to provide health care\n\nservices, procedures or supplies in the ordinary course of business\n\nor practice of a profession.","path":["OK Code","Title 36"],"source_url":"https://www.oklegislature.gov/OK_Statutes/CompleteTitles/os36.pdf","current_through":"2026-08-14","vintage":"open-us-law v2026.08, retrieved 2026-09-14","retrieved_at":"2026-09-14T18:32:36Z","sha256":"57643353845863a83661729fed78a749588b018bee656e15a42cb181b8d15364","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-36-36-6551","next":"us-ok/okla.-stat.-tit.-36-36-6553"},"notice":"GroundRules: Original legal text. Not legal advice."}