{"data":{"id":"us-ok/okla.-stat.-tit.-36-36-6561","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 36, § 36-6561","heading":"Refusal to issue or renew or suspension or revocation of","body":"certificate - Hearing - Appeal.\n\nA. The Insurance Commissioner may refuse to issue or renew or\n\nmay suspend or revoke a certificate if the holder does not comply\n\nwith performance assurances under this section, violates any\n\nprovision of the Hospital and Medical Services Utilization Review\n\nAct, or violates any rule adopted pursuant thereto.\n\nB. The Commissioner shall deny or refuse to renew a certificate\n\nto any applicant if, upon review of the application, the\n\nCommissioner finds that the applicant proposing to conduct\n\nutilization review does not:\n\n1. Have available the services of a sufficient number of\n\nqualified medical professionals supervised by appropriate health\n\ncare providers to carry out the applicant's utilization review\n\nactivities. Said sufficiency shall be based on standards and\n\ncriteria pursuant to the provisions of subparagraph b of paragraph 1\n\nof Section 8 of this act;\n\n2. Meet any applicable rules the Commissioner adopted pursuant\n\nto the Hospital and Medical Services Utilization Review Act relating\n\nto the qualifications of private review agents or the performance of\n\nutilization review; and\n\n3. Provide assurances satisfactory to the Commissioner that:\n\na. the procedure and policies of the private review agent\n\nshall protect the confidentiality of medical records,\n\nand\n\nb. the review agent shall be reasonably accessible in\n\nthis state to patients, hospitals and health care\n\nproviders as required by this act.\n\nC. Before denying, not renewing, or revoking a certificate, the\n\nCommissioner shall provide the applicant or certificate holder with\n\nreasonable time to supply additional information demonstrating\n\ncompliance with the requirements of the Hospital and Medical\n\nServices Utilization Review Act and the opportunity to request a\n\nhearing. If an applicant or certificate holder requests a hearing,\n\nthe Commissioner shall send a hearing notice and conduct a hearing\n\nin accordance with the Administrative Procedures Act.\n\nD. Any person aggrieved by a final decision of the Commissioner\n\nin a contested case may appeal the decision as provided for in the\n\nAdministrative Procedures Act.","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":"72bfa561625eb0d832afd92bbfc18d07b08888154d6e0757a7ed6c4328c85590","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-36-36-6560","next":"us-ok/okla.-stat.-tit.-36-36-6562"},"notice":"GroundRules: Original legal text. Not legal advice."}