Okla. Admin. Code § 365:40-5-122

Current through Vol. 42, No. 8, January 2, 2025

Section 365:40-5-122 - Responsibilities

An HMO or its employees and agents shall not:

(1) Pay claims reviewers based on reductions, unless the reductions are based on uniformly applied protocols designed to detect billing errors and duplicate charges;

(2) Compel a subscriber or provider to:

(A) Accept less than the full settlement of a claim; or

(B) File suit to obtain full settlement; or

(3) Knowingly misrepresent reimbursement criteria or time limits to a subscriber, provider, or their representatives.

Okla. Admin. Code § 365:40-5-122

Added at 21 Ok Reg 77, eff 11-1-03 (emergency); Added at 21 Ok Reg 1672, eff 7-14-04