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OHCA Policies and Rules

OHCA Policies and Rules Main Page

 

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.

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Oklahoma Health Care Authority

4345 N Lincoln Blvd

Oklahoma City, OK 73105

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The Oklahoma Health Care Authority collects the personally identifiable data submitted and received in regard to applications for services, renewals, appeals, provision of health care and processing of claims. This data is treated as confidential and is stored securely in accordance with applicable law and regulations. OHCA may share this personally identifiable data with its authorized business associates, government agencies with jurisdiction over the OHCA, or as otherwise required or permitted by applicable law.