SECTION 365:10-1-31. Definitions

  The following words or terms, when used in this Part, shall have the following meaning, unless the context clearly indicates otherwise:

"ADA-1990 Dental Claim Form" means the uniform dental claim form approved by the American Dental Association for use by dentists.

"CDT-1 Codes" means the current dental terminology, and its successors, required by the American Dental Association.

"CPT-4 Codes" means the current procedural terminology published by the American Medical Association.

"HCFA" means the federal Health Care Financing Administration of the United States Department of Health and Human Services.

"HCFA Form 1491" means the health insurance claim form and its electronic successor or equivalent published by HCFA for use by health care practitioners to be used in filing claims for transportation and/or ambulance services.

"HCFA Form 1500" means the health insurance claims form and its electronic successor or equivalent published by HCFA for use by health care practitioners.

"HCFA Form UB-82" means the health insurance claim form and its electronic successor or equivalent published by HCFA for use by hospitals.

"HCFA Form UB-92" means the health insurance claim form and its electronic successor or equivalent published by HCFA for use by hospitals.

"HCPCS" means HCFA's current common procedure coding system.

"Health care practitioner" means:

(A)   a chiropractor licensed under 59 O.S. §161.1 et seq.,

(B)   a corporation or partnership of health care practitioners as defined in this section and licensed under 59 O.S. §510,

(C)   a dentist licensed under 59 O.S. §328.60 et seq.,

(D)   a nurse licensed under 59 O.S. §567.1 et seq.,

(E)   a certified registered nurse anesthetist licensed under 59 O.S. §567.51,

(F)   a nurse-midwife licensed under 59 O.S. §577.1 et seq.,

(G)   an ophthalmologist licensed under 59 O.S. §481 et seq.,

(H)   an optometrist licensed under 59 O.S. §581 et seq.,

(I)   a physician licensed under 59 O.S. §481 et seq.,

(J)   a podiatrist licensed under 59 O.S. §135.1 et seq.,

(K)   a psychologist licensed under 59 O.S. §1351 et seq.,

(L)   therapists:

(i)   a speech therapist licensed under 59 O.S. §1601 et seq.,

(ii)   a physical therapist licensed under 59 §887.1 et seq.,

(iii)   an occupational therapist licensed under 59 O.S. §888.1 et seq.

(M)   an osteopath licensed under 59 O.S. §620 et seq.,

(N)   a licensed social worker under 59 O.S. §1261.1 et seq.,

(O)   a licensed professional counselor licensed under 59 O.S. §1901 et seq.

"Hospital" means a hospital as defined in 63 O.S. §§1-701.

"ICD-10 Codes" means the current disease codes in the international classification of diseases published by the United States Department of Health and Human Services.

"Third party payor" means a person that administers or provides reimbursement for health care benefits on an expense incurred basis including:

(A)   Health Maintenance Organization issued a certificate of authority in accordance with 63 O.S. §2501, et seq.,

(B)   health insurer or nonprofit health service plan authorized to offer health insurance policies or contracts in this State in accordance with 36 O.S. §2601, et seq., or

(C)   third party administrator registered under 36 O.S. §1441 et seq.

[Source: Added at 11 Ok Reg 3295, eff 7-1-94; Amended at 29 Ok Reg 1254, eff 7-14-12]