OHCA Policies and Rules

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Part 1      INDIVIDUAL PLAN PROVIDERS

317:45-11-1.Insure Oklahoma Individual Plan providers
[Revised 06-25-11]
Insure Oklahoma Individual Plan (IP) providers must comply with existing SoonerCare rules found at 317:25 and 317:30. In order to receive reimbursement, the IP provider:
(1) must enter into a SoonerCare contract; and
(2) must complete Insure Oklahoma IP addendum if provider wants to provide primary care services as a PCP.
317:45-11-2.Insure Oklahoma IP provider payments
[Revised 06-25-11]
Payment for covered benefits rendered to Insure Oklahoma IP members is made to contracted Insure Oklahoma IP healthcare providers for medical and surgical services within the scope of OHCA's medical programs, provided the services are medically necessary as defined in 317:30-3-1(f).
(1) Coverage of certain services requires prior authorization and may be based on a determination made by a medical consultant in individual circumstances;
(2) The decision to charge a co-payment for a missed visit is at the provider's discretion;
(3) The provider may collect the member's co-payment in addition to the SoonerCare reimbursement for services provided; and
(4) The provider may refuse to see members based on their inability to pay their co-payment.

Disclaimer. The OHCA rules found on this Web site are unofficial. The official rules are published by the Oklahoma Secretary of State Office of Administrative Rules as Title 317 of the Oklahoma Administrative Code. To order an official copy of these rules, contact the Office of Administrative Rules at (405) 521-4911.