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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 11. COORDINATION OF BENEFITS |
SECTION 365:40-5-54. Benefit payments
Latest version.
- Carriers shall use the following claims administration procedures to expedite claim payments where COB is involved:(1) Improving exchange of benefit information.(A) There should be continued and improved education of claim personnel stressing accurate and prompt completion of the HIC Duplicate Coverage Inquiry (DUP-1) Form by the inquiring carrier and the responding carrier. This education effort should also be encouraged through local claim associations. An HMO may use a form substantially similar to the HIC Duplicate Coverage Inquiry (DUP-1) Form if approved by the Insurance Commissioner prior to its use.(B) Claim personnel should be encouraged to make every effort, including use of the telephone, to speed up exchange of COB information. All carriers shall respond to inquiries at least thirty (30) days from receipt of such inquiries.(C) Carriers should encourage building a local date file of other group plans in the area, with at least basic information on group health plans for major employers.(2) Time limits for payment. Each carrier shall establish a time limit after which full or partial payment should be made. When payment of a claim is necessarily delayed for reasons other than the application of a COB provision, investigation of other valid coverage should be conducted concurrently so as to create no further delay in the ultimate payment on benefits.