{"data":{"id":"us-ok/okla.-stat.-tit.-36-36-6558","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 36, § 36-6558","heading":"Information required to be submitted by private review","body":"agents.\n\nIn conjunction with an application for a certificate, the\n\nprivate review agent shall submit information that the Insurance\n\nCommissioner requires, including, but not limited to:\n\n1. A utilization review plan that includes:\n\na. an adequate summary description of review standards,\n\nprotocol and procedures to be used in evaluating\n\nproposed or delivered hospital and medical care,\n\nb. assurances that the standards and criteria to be\n\napplied in review determinations are established with\n\ninput from health care providers representing major\n\nareas of specialty and certified by the boards of the\n\nvarious American medical specialties. The entity\n\nshall provide the Commissioner with a list of such\n\nrepresentatives and their major areas of specialty\n\nupon request, and\n\nc. the provisions by which patients or health care\n\nproviders may seek reconsideration or appeal of\n\nadverse decisions by the private review agent;\n\n2. The type and qualifications of the personnel either employed\n\nor under contract to perform the utilization review;\n\n3. The procedures and policies to ensure that a representative\n\nof the private review agent is reasonably accessible, if domiciled\n\nin this state, to patients and health care providers five (5) days a\n\nweek during normal business hours, such procedures and policies to\n\ninclude as a requirement a toll-free telephone number to be\n\navailable during said business hours; provided, in the alternative,\n\nthe out-of-state private review agent shall be available or make\n\nstaff available by toll-free telephone for at least forty (40) hours\n\nper week during normal business hours and shall have a telephone\n\nsystem which is capable of accepting or recording incoming telephone\n\ncalls during other than normal hours, and shall respond to such\n\ncalls within two (2) working days, if sufficient information is\n\nprovided to whomever accepts the call or on a recorded message;\n\n4. The policies and procedures to ensure that all applicable\n\nstate and federal laws to protect the confidentiality of individual\n\nmedical records are followed;\n\n5. The policies and procedures to verify the identity and\n\nauthority of personnel performing utilization review by telephone;\n\n6. A copy of the materials designed to inform applicable\n\npatients and health care providers of the requirements of the\n\nutilization review plan;\n\n7. A list of the third party payors for which the private\n\nreview agent is performing utilization review in this state. Said\n\nlist may be deemed confidential by the Commissioner for the purpose\n\nof protecting competition between agents;\n\n8. The procedures for receiving and handling complaints by\n\npatients and health care providers concerning utilization review;\n\nand\n\n9. Procedures to ensure that after a request for medical\n\nevaluation, treatment, or procedures has been rejected in whole or\n\nin part and in the event a copy of the report on said rejection is\n\nrequested, a copy of the report of a private review agent concerning\n\nthe rejection shall be mailed by the insurer, postage prepaid, to\n\nthe ill or injured person, the treating health care provider or to\n\nthe person financially responsible for the patient's bill within\n\nfifteen (15) days after receipt of the request for the report.","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":"b16e186a4be37d68923e20e0d08d41cfd31f1efd65d3abec5813b4b3c6d20901","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-36-36-6557","next":"us-ok/okla.-stat.-tit.-36-36-6559"},"notice":"GroundRules: Original legal text. Not legal advice."}