Oklahoma Administrative Code
Title 317 - Oklahoma Health Care Authority
Chapter 30 - Medical Providers-Fee for Service
Subchapter 5 - Individual Providers and Specialties
Part 110 - INDIAN HEALTH SERVICES, TRIBAL PROGRAMS, AND URBAN INDIAN CLINICS (I/T/US)
Section 317:30-5-1099 - I/T/U service limitations and requirements
Current through Vol. 42, No. 1, September 16, 2024
Service limitations governing the provision of all Oklahoma SoonerCare services will apply pursuant to Chapter 30 of the OHCA rules. In addition, the following limitations and requirements apply to services provided by I/T/U facilities:
(1) Multiple encounters. An I/T/U facility may bill for more than one encounter per twenty-four (24) hour period under certain conditions.
(2) Behavioral Health services. Behavioral Health Services are limited to those services furnished to members at or on behalf of the I/T/U facility.
(3) Laboratory procedures. Laboratory procedures performed by an I/T/U outpatient facility (not an independently certified enrolled laboratory) on the same date of service are considered part of the health care practitioner's service and are included in the I/T/U encounter.
(4) Obstetrical services. For OB services provided to a member before, during, and/or after the same pregnancy, ITUs may not bill for individual encounters and the package/bundled rate. Providers may only either:
Added at 23 Ok Reg 2575, eff 6-25-06; Amended at 25 Ok Reg 2698, eff 7-25-08
