§36-6570.8. Time frame in which prior authorization may not be
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/ok/title-36-insurance/36-6570-8·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
altered — Contracted payment rate requirement and exceptions.
A. A health benefit plan may not revoke, limit, condition, or restrict a prior authorization if care is provided within forty-five
(45)business days from the date the health care provider received
the prior authorization unless the enrollee was no longer eligible for care on the day care was provided.
B. A health benefit plan must pay a contracted health care provider at the contracted payment rate for a health care service provided by the health care provider per a prior authorization, unless:
1. The health care provider knowingly and materially misrepresented the health care service in the prior authorization request with the specific intent to deceive and obtain an unlawful payment from a utilization review entity;
2. The health care service was no longer a covered benefit on the day it was provided;
3. The health care provider was no longer contracted with the patient's health benefit plan on the date the care was provided;
4. The health care provider failed to meet the utilization review entity's timely filing requirements; or
5. The patient was no longer eligible for health care coverage on the day the care was provided. Added by Laws 2024, c. 303, § 9, eff. Jan. 1, 2025.