Oklahoma Administrative Code
Title 310 - Oklahoma State Department of Health
Chapter 657 - Certified Workplace Medical Plans
Subchapter 29 - Restricted and Prohibited Acts
Section 310:657-29-2 - Prohibited acts
Universal Citation: OK Admin Code 310:657-29-2
Current through Vol. 42, No. 1, September 16, 2024
(a) No person may operate a Plan in Oklahoma, nor use the phrase "workplace medical plan," nor imply that it is a workplace medical plan, unless that person first obtains a certificate.
(b) No Plan shall imply that certification qualifies the Plan to provide services except as authorized under the Act and OAC 310:657.
(c) A Plan, 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 an injured worker or a provider
to:
(A) Accept less than the full settlement
of a claim;
(B) File suit to obtain
full settlement;
(C) Accept a
lesser, interim figure as a premature final settlement; or
(3) Knowingly misrepresent reimbursement
criteria and time frames to employees, a provider, an insurer, an insured, or
their representatives.
Added at 12 Ok Reg 2977, eff 6-16-95 (emergency); Added at 13 Ok Reg 2127, eff 6-13-96; Amended at 14 Ok Reg 2264, eff 6-12-97; Amended at 23 Ok Reg 2404, eff 6-25-06
Disclaimer: These regulations may not be the most recent version. Oklahoma may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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