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Oklahoma Administrative Code (Last Updated: March 11, 2021) |
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TITLE 365. Insurance Department |
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Chapter 40. Health Maintenance Organizations (HMO) |
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Subchapter 5. Life, Accident & Health Division and Consumer Assistance and Claims Division Rules |
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Part 23. REIMBURSEMENT OF CLAIMS |
SECTION 365:40-5-125. Elements of a clean claim
Latest version.
- (a) Required clean claim elements. A provider submits a clean claim by providing the required data elements specified in O.A.C. 365:40-5-123 to an HMO along with any attachments and additional elements information of which the provider has been properly notified pursuant to O.A.C. 365:40-5-126.(b) Attachments. The Center for Medicare and Medicaid Services has developed a variety of manuals that identify various attachments required of different providers for specific services. An HMO may use the appropriate Medicare standards for attachments in order to properly process claims for certain types of services. An HMO shall only require as attachments information that is either contained in or in the process of being incorporated into a patient's medical or billing record maintained by the provider. Before any attachments may be required, the HMO shall satisfy the notification procedures set forth in O.A.C. 365:40-5-126.(c) Additional clean claim elements. Before any additional clean claim elements may be required, the HMO shall satisfy the notification procedures set forth in O.A.C. 365:40-5-126. An HMO shall only require as additional clean claim elements information that is either contained in or in the process of being incorporated into a patient's medical or billing record maintained by the provider.