§ 6971. Electronic provider directories for health benefit plans
Oklahoma Statutes AnnotatedTitle 36. InsuranceEffective: November 1, 2023
Effective: November 1, 2023
36 Okl.St.Ann. § 6971
§ 6971. Electronic provider directories for health benefit plans
B. Any insurer of a health benefit plan that is offered, issued, or renewed in this state on or after the effective date of this act1 shall publish an electronic provider directory for each of its network plans, to be updated every sixty (60) days. The insurer shall make clear the provider directory that applies to each network plan as marketed and issued in this state. The electronic directory shall be published on an easily accessible website in a standardized, downloadable, and searchable format. The electronic directory shall include the following information:
C. Any insurer of a health benefit plan that publishes a provider directory pursuant to this section shall ensure that the general public is able to view all of the current providers for a network plan, through a clearly identifiable hyperlink or website tab, without requiring any person to create or sign into an account or submit a policy or contract number.
b. how the plan designates the different provider tiers or levels, including, but not limited to, by name, symbols, or grouping, in the network and for each specific provider in the network, which tier each is placed for an insured or a prospective insured to be able to identify the provider tier, and
2. The plan shall include a disclosure in any print directory issued under this subsection that the information in the directory is accurate as of the date of printing and that an insured or prospective insured should consult the electronic provider directory on the website of the plan or call the listed customer service telephone number to obtain current provider directory information.
F. 1. The health benefit plan shall include in both its online and print directories, if offered, a clearly identifiable telephone number, email address, or link to a webpage which an insured or the general public may use to report to the plan inaccurate information listed in the provider directory. Whenever a plan receives a report, it shall promptly investigate the report and, not later than two (2) days following the receipt of such report, either verify the accuracy of the information or update the information.
3. The plan shall, at least annually, audit its provider directories for accuracy. The audit should be focused on the top four utilized specialties to include at least one specialty related to mental health. Alternatively, plans may audit based on a reasonable sample size of providers, as long as the sample size includes behavioral health providers. The plan shall retain documentation of any audit conducted under this paragraph to be made available to the Insurance Commissioner. Based on the results of a given audit, the plan shall verify and attest to the accuracy of the information or update the information.
G. An insurer of a health benefit plan shall, by certified mail, return receipt requested, or by electronic mail, read receipt requested, notify any provider of its removal from the network if the provider has not submitted claims to the plan or otherwise communicated intent to continue participation in the plan network within a twelve-month period. If the provisions of the contract entered between the plan and the provider provides notice terms, the notice shall be provided in accordance with such terms. If the plan does not receive a response from the provider within thirty (30) days of such notification, the plan shall remove the provider from the network.
I. If an insured reasonably relies upon materially inaccurate information contained in a provider directory of a plan, the Commissioner may require the plan to provide coverage for all covered health care services provided to the insured and to reimburse the insured for any amount that he or she would have to pay if the services would have been delivered by an in-network provider under the network plan. Provided, the Commissioner shall take into consideration that health benefit plan insurers are relying on health care providers to report changes to their information prior to requiring any reimbursement to an insured. In the event that the Commissioner finds that the provider has not provided updated information for the network directory of the insurer of a health benefit plan, the Commissioner may require that the provider be reimbursed at the assignment of benefits rate for the service if it were conducted in-network. Prior to requiring reimbursement under this subsection, the Commissioner shall conclude that the services received by the plan were covered services under the insured's network plan. If the services satisfy requirements of this subsection, a plan shall not deny reimbursement to an insured based on the provider of the services being out-of-network.
Credits
Laws 2023, c. 191, § 1, eff. Nov. 1, 2023.
Footnotes
O.S.L. 2023, c. 191, eff. Nov. 1, 2023.
36 Okl. St. Ann. § 6971, OK ST T. 36 § 6971
Current with emergency effective legislation through Chapter 295 of the Second Regular Session of the 59th Legislature (2024). Some sections may be more current, see credits for details.
End of Document |