Okla. Admin. Code § 365:40-5-128

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

Section 365:40-5-128 - Failure to promptly pay

(a) An HMO that fails to comply with the requirements in Titles 36 of the Oklahoma Statutes regarding reimbursement of claims and with this Part shall pay the greater of:

(1) The penalty amount for late payment referred to in applicable provisions in Title 36 of the Oklahoma Statutes; or

(2) The contracted penalty rate for late payment set forth in the contract between the provider and the HMO.

(b) Failure to pay the correct amount on a clean claim in accordance with the contract or denial of a clean claim for which payment should have been made that results in a failure to comply with the requirements of applicable provisions in Title 36 of the Oklahoma Statutes and this Part is considered a violation and may be subject to administrative penalties as set forth in HMO Act.

(c) Any amount previously paid or any charge for a non-covered service shall be deducted from the payment.

Okla. Admin. Code § 365:40-5-128

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