{"data":{"id":"us-ok/okla.-stat.-tit.-36-36-6559","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 36, § 36-6559","heading":"Information required to be submitted relating to in-house","body":"review.\n\nA. Insurance companies and not-for-profit hospital services and\n\nmedical indemnity plans licensed by the Commissioner that perform\n\nin-house utilization review shall submit to the Commissioner the\n\nfollowing information regarding utilization review:\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, and\n\nc. the provisions by which patients or health care\n\nproviders may seek reconsideration or appeal of\n\nadverse decisions concerning requests for medical\n\nevaluation, treatment or procedures;\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\nis reasonably accessible to patients and health care providers five\n\n(5) days a week during normal business hours, such procedures and\n\npolicies to include as a requirement a toll-free telephone number to\n\nbe available during said business hours; provided, in the case of\n\ninsurance companies, if the personnel performing utilization review\n\nare out-of-state, the personnel shall be available or make staff\n\navailable by toll-free telephone for at least forty (40) hours per\n\nweek during normal business hours and shall have a telephone system\n\nwhich is capable of accepting or recording incoming telephone calls\n\nduring other than normal hours, and shall respond to such calls\n\nwithin two (2) working days, if sufficient information for response\n\nis provided 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. The procedures for receiving and handling complaints by\n\npatients, hospitals and health care providers concerning utilization\n\nreview; and\n\n8. 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 the personnel performing\n\nutilization review concerning the rejection shall be mailed by the\n\ninsurer, postage prepaid, to the ill or injured person, the treating\n\nhealth care provider, hospital or to the person financially\n\nresponsible for the patient's bill within fifteen (15) days after\n\nreceipt of the request for the report.\n\nB. Insurance companies that provide for in-house utilization\n\nreview shall pay an annual fee to the Insurance Commissioner of Five\n\nHundred Dollars ($500.00).","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":"0b798f61be45233c08c02e93e0e8b7f38763a3d00d75db30f0067439bef9ae71","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-36-36-6558","next":"us-ok/okla.-stat.-tit.-36-36-6560"},"notice":"GroundRules: Original legal text. Not legal advice."}