Okla. Admin. Code § 365:40-5-129

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

Section 365:40-5-129 - Date of claim receipt

(a) A provider and an HMO may agree by contract to establish a procedure to create a rebuttable presumption regarding the date of claim receipt.

(b) If a provider and HMO do not by contract agree to a method for the establishment of a rebuttable presumption, then the procedures set forth in subsections (c) through (e) of this Section shall be used to establish a rebuttable presumption to demonstrate the date of claim receipt.

(c) The provider shall maintain a claims summary report to identify each claim and identify the batch to which multiple claims were a part. The claims summary report shall be used as a means of confirming the number of claims submitted.

(d) The summary report shall accompany each batched filing, except for electronic submissions.

(e) The provider shall submit a claim or a multiple claim batch by one of the following methods, as appropriate:

(1) United States mail first class. Claim(s) submitted by United States mail first class will be considered received on the seventh business day after the date the claim(s) was placed in the mail;

(2) Certified mail. Claim(s) submitted by certified mail will be considered received on the date the delivery receipt is signed;

(3) Overnight delivery. Claim(s) submitted by overnight delivery will be considered received on the date the delivery receipt is signed;

(4) Electronically. Claim(s) submitted electronically will be considered received on the date of verification of receipt by the HMO or the HMO's clearinghouse. Claims are to be accompanied by any system-generated proof of transmission. If the HMO or its clearinghouse do not confirm receipt or reject the transmission within 24 hours of submission, the provider or the provider's clearinghouse shall provide the confirmation date conditional upon the provider or the provider's clearinghouse verifying the claim(s) contained the correct payor identification;

(5) Facsimile. Claim(s) submitted by facsimile will be considered received on the date of the facsimile confirmation, or if the transmission occurs after the HMO's working hours, on the HMO's next working day; or

(6) Hand delivery. Claim(s) submitted by hand delivery will be considered received on the date the delivery receipt is signed.

Okla. Admin. Code § 365:40-5-129

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