{"data":{"id":"us-ok/okla.-stat.-tit.-36-36-6971","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 36, § 36-6971","heading":"Electronic provider directories for health benefit plans","body":"A. As used in this section:\n\n1. “Health benefit plan” means a plan as defined pursuant to\n\nSection 6060.4 of Title 36 of the Oklahoma Statutes;\n\n2. “Health care facility” means a facility as defined pursuant\n\nto Section 1-725.2 of Title 63 of the Oklahoma Statutes;\n\n3. “Health care professional” means a professional as defined\n\npursuant to Section 6802 of Title 36 of the Oklahoma Statutes;\n\n4. “Hospital” means a hospital as defined pursuant to Section\n\n1-701 of Title 63 of the Oklahoma Statutes; and\n\n5. “Provider” means a health care provider as defined pursuant\n\nto Section 6571 of Title 36 of the Oklahoma Statutes.\n\nB. Any insurer of a health benefit plan that is offered,\n\nissued, or renewed in this state on or after the effective date of\n\nthis act shall publish an electronic provider directory for each of\n\nits network plans, to be updated every sixty (60) days. The insurer\n\nshall make clear the provider directory that applies to each network\n\nplan as marketed and issued in this state. The electronic directory\n\nshall be published on an easily accessible website in a\n\nstandardized, downloadable, and searchable format. The electronic\n\ndirectory shall include the following information:\n\n1. For health care professionals:\n\na. name,\n\nb. contact information, including a website address,\n\nphysical address, and phone number, and\n\nc. specialty, if applicable;\n\n2. For hospitals:\n\na. hospital name,\n\nb. hospital type, including, but not limited to, acute,\n\nrehabilitation, children’s, or cancer,\n\nc. participating hospital location,\n\nd. hospital accreditation status,\n\ne. customer service telephone number, and\n\nf. website address; and\n\n3. For health care facilities other than hospitals:\n\na. facility name,\n\nb. facility type,\n\nc. types of services performed,\n\nd. participating facility location or locations,\n\ne. customer service telephone number, and\n\nf. website address.\n\nC. Any insurer of a health benefit plan that publishes a\n\nprovider directory pursuant to this section shall ensure that the\n\ngeneral public is able to view all of the current providers for a\n\nnetwork plan, through a clearly identifiable hyperlink or website\n\ntab, without requiring any person to create or sign into an account\n\nor submit a policy or contract number.\n\nD. For each network plan published, an insurer of a health\n\nbenefit plan shall include in plain language the following\n\ninformation:\n\n1. A description of the criteria used to build its provider\n\nnetwork; and\n\n2. If applicable:\n\na. a description of the criteria used to tier providers,\n\nb. how the plan designates the different provider tiers\n\nor levels, including, but not limited to, by name,\n\nsymbols, or grouping, in the network and for each\n\nspecific provider in the network, which tier each is\n\nplaced for an insured or a prospective insured to be\n\nable to identify the provider tier, and\n\nc. a notice that authorization or referral may be\n\nrequired to access some providers.\n\nE. 1. Provider directories, whether in electronic or, if\n\noffered, print format, shall be accessible to individuals with\n\ndisabilities and individuals with limited English proficiency as\n\ndefined in 45 C.F.R. Sections 92.201 and 155.205.\n\n2. The plan shall include a disclosure in any print directory\n\nissued under this subsection that the information in the directory\n\nis accurate as of the date of printing and that an insured or\n\nprospective insured should consult the electronic provider directory\n\non the website of the plan or call the listed customer service\n\ntelephone number to obtain current provider directory information.\n\nF. 1. The health benefit plan shall include in both its online\n\nand print directories, if offered, a clearly identifiable telephone\n\nnumber, email address, or link to a webpage which an insured or the\n\ngeneral public may use to report to the plan inaccurate information\nn the website of the plan or call the listed customer service\n\ntelephone number to obtain current provider directory information.\n\nF. 1. The health benefit plan shall include in both its online\n\nand print directories, if offered, a clearly identifiable telephone\n\nnumber, email address, or link to a webpage which an insured or the\n\ngeneral public may use to report to the plan inaccurate information\n\nlisted in the provider directory. Whenever a plan receives a\n\nreport, it shall promptly investigate the report and, not later than\n\ntwo (2) days following the receipt of such report, either verify the\n\naccuracy of the information or update the information.\n\n2. A plan shall take appropriate steps to ensure the accuracy\n\nof the information concerning each provider listed in the provider\n\ndirectory. The plan shall contact providers as necessary to ensure\n\nthat the information provided in the directory is up to date.\n\n3. The plan shall, at least annually, audit its provider\n\ndirectories for accuracy. The audit should be focused on the top\n\nfour utilized specialties to include at least one specialty related\n\nto mental health. Alternatively, plans may audit based on a\n\nreasonable sample size of providers, as long as the sample size\n\nincludes behavioral health providers. The plan shall retain\n\ndocumentation of any audit conducted under this paragraph to be made\n\navailable to the Insurance Commissioner. Based on the results of a\n\ngiven audit, the plan shall verify and attest to the accuracy of the\n\ninformation or update the information.\n\nG. An insurer of a health benefit plan shall, by certified\n\nmail, return receipt requested, or by electronic mail, read receipt\n\nrequested, notify any provider of its removal from the network if\n\nthe provider has not submitted claims to the plan or otherwise\n\ncommunicated intent to continue participation in the plan network\n\nwithin a twelve-month period. If the provisions of the contract\n\nentered between the plan and the provider provides notice terms, the\n\nnotice shall be provided in accordance with such terms. If the plan\n\ndoes not receive a response from the provider within thirty (30)\n\ndays of such notification, the plan shall remove the provider from\n\nthe network.\n\nH. In accordance with any timeframes and requirements that may\n\nbe established by the Commissioner, an insurer of a health benefit\n\nplan shall report to the Commissioner the following:\n\n1. The number of reports received pursuant to subsection F of\n\nthis section, the timeliness of the response from the plan, and the\n\ncorrective action or actions taken; and\n\n2. All auditing reports conducted by the plan pursuant to\n\nsubsection F of this section.\n\nI. If an insured reasonably relies upon materially inaccurate\n\ninformation contained in a provider directory of a plan, the\n\nCommissioner may require the plan to provide coverage for all\n\ncovered health care services provided to the insured and to\n\nreimburse the insured for any amount that he or she would have to\n\npay if the services would have been delivered by an in-network\n\nprovider under the network plan. Provided, the Commissioner shall\n\ntake into consideration that health benefit plan insurers are\n\nrelying on health care providers to report changes to their\n\ninformation prior to requiring any reimbursement to an insured. In\n\nthe event that the Commissioner finds that the provider has not\n\nprovided updated information for the network directory of the\n\ninsurer of a health benefit plan, the Commissioner may require that\n\nthe provider be reimbursed at the assignment of benefits rate for\n\nthe service if it were conducted in-network. Prior to requiring\n\nreimbursement under this subsection, the Commissioner shall conclude\n\nthat the services received by the plan were covered services under\n\nthe insured’s network plan. If the services satisfy requirements of\n\nthis subsection, a plan shall not deny reimbursement to an insured\nrovider be reimbursed at the assignment of benefits rate for\n\nthe service if it were conducted in-network. Prior to requiring\n\nreimbursement under this subsection, the Commissioner shall conclude\n\nthat the services received by the plan were covered services under\n\nthe insured’s network plan. If the services satisfy requirements of\n\nthis subsection, a plan shall not deny reimbursement to an insured\n\nbased on the provider of the services being out-of-network.\n\nJ. The Commissioner may promulgate rules to effectuate the\n\nprovisions of this section.","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":"9b3aa4c19257dd555e27c147ce418c01846dcbf1f3925e990bb1c6458d11b9b1","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-36-36-6969","next":"us-ok/okla.-stat.-tit.-36-36-6972"},"notice":"GroundRules: Original legal text. Not legal advice."}