SECTION 365:10-15-5. Use of Oklahoma physician in utilization review

(a)   Every private review agent shall have an appropriate number of Oklahoma licensed physicians and/or Oklahoma licensed health care professionals who are involved in supervising the private review agent's utilization review activities. Such Oklahoma licensed physicians and Oklahoma licensed health care professionals shall actively participate in the private review agent's appeal process and complaint process.

(b)   The term "appropriate number", as used in the preceding paragraph, shall mean a reasonable amount of Oklahoma licensed physicians and/or Oklahoma licensed health care professionals to adequately supervise the private review agent's utilization review activities, depending upon the utilization review activities undertaken by the private review agent, but shall in no event be construed to be less than one Oklahoma licensed physician or Oklahoma licensed health care professional.

[Source: Added at 14 Ok Reg 2957, eff 7-14-97]