SECTION 340:75-13-63. Prior authorization and claims procedures for medical services

  Prior authorization is required for medical services, per Oklahoma Administrative Code (OAC) 317:30-3-82. Procedures and guidelines for prior authorization are outlined in OAC 317:30-3-82, available to all healthcare providers at www.ohca.state.ok.us.

(1)   Contact Oklahoma Health Care Authority (OHCA). For services, supplies, or equipment requiring prior authorization, the healthcare provider contacts the OHCA-contracted agency for specific instructions and assistance.

(2)   Contact Child Welfare Services (CWS) Finance and Business Operations (FBO). When child welfare (CW) staff or placement providers are referred to a collection agency for nonpayment of a medical bill for a child in Oklahoma Department of Human Services custody, CW staff contacts CWS FBO for guidance regarding payment procedures. Any medical payments made from state funds are paid at rates no greater than established Oklahoma Medicaid rates.

[Source: Amended at 11 Ok Reg 505, eff 11-15-93 (emergency); Amended at 11 Ok Reg 1733, eff 5-12-94; Amended at 16 Ok Reg 102, eff 10-13-98 (preemptive); Amended at 22 Ok Reg 854, eff 5-12-05; Amended at 24 Ok Reg 1323, eff 6-1-07; Amended at 28 Ok Reg 894, eff 7-1-11; Amended at 37 Ok Reg 1850, eff 9-15-20]