Oklahoma Administrative Code
Title 317 - Oklahoma Health Care Authority
Chapter 30 - Medical Providers-Fee for Service
Subchapter 5 - Individual Providers and Specialties
Part 6 - INPATIENT PSYCHIATRIC AND SUBSTANCE USE DISORDER SERVICES
Section 317:30-5-96.8 - Psychiatric Residential Treatment Facility payments to subcontractors
Current through Vol. 42, No. 1, September 16, 2024
(a) Psychiatric Residential Treatment Facilities (PRTFs) that receive a pre-determined all-inclusive per diem payment must provide routine, ancillary and professional services. In the event the member receives an ancillary service, the PRTF is responsible for making timely payment to the subcontractor or other provider.
(b) For purposes of subsection (a) of this Section, timely payment or adjudication means payment or denial of a clean claim within 45 days of presentation to the PRTF.
(c) No subcontractor of the PRTF may charge more than the OHCA fee schedule for SoonerCare compensable services.
(d) The subcontractor may not bill the SoonerCare member until the PRTF has refused payment.
Added at 25 Ok Reg 673, eff 2-1-08 through 7-14-08 (emergency)1; Added at 25 Ok Reg 2703, eff 7-25-08
1This emergency action expired before being superseded by a permanent action. Upon expiration of an emergency action enacting a new Section, the Section is no longer effective. Therefore, on 7-15-08 (after the 7-14-08 expiration of this emergency action), Section 317:30-5-96.8 was no longer effective, and remained as such until added again by permanent action on 7-25-08.
