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Oklahoma Administrative Code (Last Updated: March 11, 2021) |
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TITLE 260. Office of Management and Enterprise Services |
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Chapter 45. Employees Group Insurance Division - Administrative and General Provisions |
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Subchapter 1. Purpose, Definitions, Rules and References |
SECTION 260:45-1-2. Definitions
Latest version.
- The following words and terms as defined by EGID shall have the following meaning unless the content clearly indicates otherwise:"Adverse determination" means a determination by or on behalf of EGID or its designee utilization review organization that an admission, availability of care, continued stay or other healthcare service is a covered benefit but, after review, based upon the information provided, does not meet EGID's requirements for medical necessity, appropriateness, health care setting, level of care or effectiveness, and the requested service is therefore denied, reduced, or terminated."EGID" means the Employees Group Insurance Division of the Office of Management and Enterprise Services."Grievance Panel" means EGID's independent constitutionally created administrative court. [Const. Art. 7. § 1.]"Independent review organization" means a properly accredited entity that conducts independent external reviews of adverse determinations on behalf of EGID."OEIBB" means the Oklahoma Employees Insurance and Benefits Board.