SUBCHAPTER 3 - Member Grievances and Appeals, Provider Complains, and State Fair Hearings in SoonerSelect
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Section 1. Definitions -
Section 2. Timeframes -
Section 3. Grievance and appeals system -
Section 4. Member grievances -
Section 5. Member appeals -
Section 5.1. Continuation of benefits pending appeal and state fair hearing -
Section 6. External medical review and clinical expertise -
Section 7. Obligation to pay costs of services -
Section 8. Grievance and appeals notices -
Section 9. Exhaustion of managed care entity appeals -
Section 10. Provider complaint system -
Section 11. Recordkeeping -
Section 12. State fair hearing for members -
Section 13. State fair hearing for providers -
Section 14. Administrative Law Judge (ALJ) jurisdiction
| Section 1 | Definitions |
| Section 2 | Timeframes |
| Section 3 | Grievance and appeals system |
| Section 4 | Member grievances |
| Section 5 | Member appeals |
| Section 5.1 | Continuation of benefits pending appeal and state fair hearing |
| Section 6 | External medical review and clinical expertise |
| Section 7 | Obligation to pay costs of services |
| Section 8 | Grievances and appeals notices |
| Section 9 | Exhaustion of managed care entity appeals |
| Section 10 | Provider complaint system and appeal requests |
| Section 11 | Recordkeeping |
| Section 12 | State fair hearing for members |
| Section 13 | State fair hearing for providers |
| Section 14 | Administrative Law Judge (ALJ) jurisdiction |
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.
