§36-6974. Credentials — Reimbursement and requirements for
293 words·~1 min read·
/ok/title-36-insurance/36-6974·A research copy — for the controlling text, always check the official state or federal source. Not legal advice.
physicians and optometrists — Subcontracts.
A. 1. No agreement between an insurer or a prepaid vision plan and a vision care provider shall require that a provider participate with or be credentialed by any specific prepaid vision plan as a condition for participation in the health care network of the insurer to provide covered services to its enrollees.
2. In the event that a vision care provider is credentialed by an insurer or vision care plan organization, no insurer or vision care plan organization shall construe re-credentialing as re- contracting with a vision care provider. All contracts shall be distinct and separate documents from any credentialing materials.
B. Any insurer issuing or renewing a health benefit plan or prepaid vision plan which provides coverage for services rendered by a duly licensed physician or osteopath that are within the scope of practice of a duly licensed optometrist shall provide the same reimbursement for services to optometrists as allowed for those services rendered by physicians or osteopaths.
C. No insurer or prepaid vision plan organization shall require an optometrist to meet terms and conditions that are not required of a physician or osteopath as a condition for participation in its provider network for the provision of services that are within the scope of practice of an optometrist.
D. If a vision care provider enters into any subcontract agreement with another provider to provide his or her licensed health care services to the enrollee, dependent of the enrollee, or an enrollee of a managed care plan where the subcontracted provider will bill the managed care plan or enrollee directly for the subcontracted services, the subcontract agreement shall meet all requirements of this act. Added by Laws 2024, c. 360, § 3, emerg. eff. May 30, 2024.