§ 7303. Prohibition on denial of claim in a prior authorization--Exceptions--Requirements
Oklahoma Statutes AnnotatedTitle 36. InsuranceEffective: November 1, 2019
Effective: November 1, 2019
36 Okl.St.Ann. § 7303
§ 7303. Prohibition on denial of claim in a prior authorization--Exceptions--Requirements
A. For the purposes of this section, “prior authorization” means any predetermination, prior authorization, or similar authorization that is verifiable, whether through issuance of letter, facsimile, email, or similar means, indicating that a specific procedure is, or multiple procedures are, covered under the patient's dental plan and reimbursable at a specific amount, subject to applicable coinsurance and deductibles, and issued in response to a request submitted by a dentist using a format prescribed by the insurer.
4. If, subsequent to the issuance of the prior authorization, new procedures are provided to the patient or a change in the condition of the patient occurs such that the prior authorized procedure would at that time required disapproval pursuant to the terms and conditions for coverage under the plan of the patient in effect at the time the prior authorization was used; or
F. The dental service contractor shall not recoup a claim solely due to a loss of coverage of a patient or ineligibility if, at the time of treatment, the contractor erroneously confirms coverage and eligibility, but had sufficient information available to it indicating that the patient was no longer covered or was ineligible for coverage.
Credits
Laws 2019, c. 437, § 1, eff. Nov. 1, 2019.
36 Okl. St. Ann. § 7303, OK ST T. 36 § 7303
Current with emergency effective legislation through Chapter 182 of the Second Regular Session of the 59th Legislature (2024). Some sections may be more current, see credits for details.
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