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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 365:40-5-126. Disclosure requirements
Latest version.
- (a) An HMO shall not require an attachment or an additional element unless it has given the provider the disclosure mandated by this Section at least sixty (60) calendar days before requiring the attachment or additional element as an element of the clean claim.(b) An HMO shall not revise its requirements for data elements, attachments or additional elements unless it has given the provider the disclosure mandated by this Section at least sixty (60) calendar days before requiring the data element, attachment or additional element.(c) The HMO shall not require claims filed during the sixty (60) day period after receipt of the disclosure to include the required attachment or additional element identified in the disclosure.(d) Methods of disclosure may include one or more of the following:(1) A written notice to all affected providers.(2) Updated revisions to the provider manual or other document that sets forth the claims filing procedures; or(3) Amendments to provider contracts that specify clean claim elements.(e) If the provider contract requires mutual agreement of the parties as the sole mechanism for requiring attachments or additional elements, then the written notice specified in this Section shall not supersede the requirement for mutual agreement.(f) All notices shall identify with specificity the attachment(s) or additional elements(s) required for a clean claim.(g) The disclosure required by this Section shall be presumed received by the provider in the manner provided in O.A.C. 365:40-5-129.