{"data":{"id":"us-ok/okla.-stat.-tit.-74-74-1328","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 74, § 74-1328","heading":"Reimbursement of claims within certain time period","body":"A. The contracted claims administrator for the Oklahoma Health\n\nCare Authority shall reimburse all clean claims of an enrollee, an\n\nassignee of the enrollee, or a health care provider within forty-\n\nfive (45) calendar days after receipt of the claim by the entity.\n\nB. As used in this section, \"clean claim\" means a claim that\n\nhas no defect or impropriety, including a lack of any required\n\nsubstantiating documentation, or particular circumstance requiring\n\nspecial treatment that impedes prompt payment.\n\nC. 1. If a claim or any portion of a claim is determined to\n\nhave defects or improprieties, including a lack of any required\n\nsubstantiating documentation, or a particular circumstance requiring\n\nspecial treatment, the enrollee, assignee of the enrollee, or health\n\ncare provider shall be notified in writing within thirty (30)\n\ncalendar days after receipt of the claim by the contracted claims\n\nadministrator for the Authority. The written notice shall specify\n\nthe portion of the claim that is causing a delay in processing and\n\nexplain any additional information or corrections needed. Failure\n\nof the Authority's claims administrator to provide the enrollee,\n\nassignee of the enrollee, or health care provider with such notice\n\nshall constitute prima facie evidence that the claim will be paid in\n\naccordance with the terms of the health benefit claims\n\nadministration contract.\n\n2. The portion of the claim that is accurate shall be paid\n\nwithin forty-five (45) calendar days after receipt of the claim by\n\nthe claims administrator for the Authority.\n\nD. Upon receipt of the additional information or corrections\n\nwhich led to the claim's being delayed and a determination that the\n\ninformation is accurate, the claims administrator for the Authority\n\nshall either pay or deny the claim or a portion of the claim within\n\nforty-five (45) calendar days.\n\nE. Payment shall be considered made on:\n\n1. The date a draft or other valid instrument which is\n\nequivalent to the amount of the payment is placed in the United\n\nStates mail in a properly addressed, postpaid envelope; or\n\n2. If not so posted, the date of delivery.\n\nF. An overdue payment shall bear simple interest at the rate of\n\nten percent (10%) per year.\n\nG. In the event litigation should ensue based upon such a\n\nclaim, the prevailing party shall be entitled to recover a\n\nreasonable attorney fee to be set by the court and taxed as costs\n\nagainst the party or parties who do not prevail.","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":"16b716575430c70cdda16d23ffe18f844abc57dceb15277950f8ef670d8651c9","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-74-74-1327","next":"us-ok/okla.-stat.-tit.-74-74-1329"},"notice":"GroundRules: Original legal text. Not legal advice."}