{"data":{"id":"us-ok/okla.-stat.-tit.-74-74-1306.2","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 74, § 74-1306.2","heading":"Information regarding utilization review - Submission","body":"to Commissioner.\n\nA. The Oklahoma Health Care Authority shall submit to the\n\nInsurance Commissioner the following information regarding\n\nutilization review performed by employees of the Authority:\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 an employee of\n\nthe Authority is reasonably accessible to patients and health care\n\nproviders five (5) days a week during normal business hours, such\n\nprocedures and policies to include as a requirement a toll-free\n\ntelephone number to be available during such business hours;\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 such 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. The Authority shall pay an annual fee to the Insurance\n\nCommissioner of Five Hundred Dollars ($500.00).","path":["OK Code","Title 74"],"source_url":"https://www.oklegislature.gov/OK_Statutes/CompleteTitles/os74.pdf","current_through":"2026-08-14","vintage":"open-us-law v2026.08, retrieved 2026-09-14","retrieved_at":"2026-09-14T18:32:36Z","sha256":"db133e3e56e1adf88d61447773351af38258a9d35340981accb739061b441438","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-74-74-1306.1","next":"us-ok/okla.-stat.-tit.-74-74-1306.5"},"notice":"GroundRules: Original legal text. Not legal advice."}