Okla. Admin. Code § 317:30-3-20

Current through Vol. 42, No. 4, November 1, 2024

Section 317:30-3-20 - Claim inquiry procedures (excluding nursing homes and hospitals)

A medical provider may request a review of the amount paid or the non-payment of medical services provided to an eligible member. If the medical provider does not agree with the adjudication of the original claim, he/she may submit an electronic request for review on the Oklahoma Health Care Authority (OHCA) provider portal in accordance with the instructions in the Provider Billing and Procedures Manual, available on OHCA's website, www.okhca.org. Documentation, including but not limited to, supporting medical documentation and/or proof of timely filing as outlined in Oklahoma Administrative Code (OAC) 317:30-3-11, must be included with each submission.

Added at 12 Ok Reg 751, eff 1-5-95 through 7-14-95 (emergency); Added at 12 Ok Reg 3131, eff 7-27-95; Amended at 13 Ok Reg 3585, eff 7-16-96 (emergency); Amended at 14 Ok Reg 1780, eff 5-27-97; Amended at 15 Ok Reg 3784, eff 7-1-98 (emergency); Amended at 16 Ok Reg 1429, eff 5-27-99; Amended at 23 Ok Reg 771, eff 3-9-06 (emergency); Amended at 23 Ok Reg 2440, eff 6-25-06

Amended by Oklahome Register, Volume 33, Issue 23, August 15, 2016, eff. 9/1/2016

Amended by Oklahoma Register, Volume 37, Issue 24, September 1, 2020, eff. 9/14/2020