OHCA Policies and Rules
| Section 1 | Creation and implementation of rules; applicability |
| Section 2 | Provider agreements |
| Section 2.1 | Program Integrity Audits/Reviews |
| Section 3 | Group billings |
| Section 3.1 | Medicaid Income Deferral Program [REVOKED] |
| Section 4 | Electronic fund transfer/direct deposit |
| Section 4.1 | Uniform Electronic Transaction Act |
| Section 5 | Assignment and cost sharing [AMENDED] |
| Section 5.1 | Usual and Customary fees |
| Section 6 | Utilization review for physician/hospital services |
| Section 7 | Care assurance validation support review for long term care [REVOKED] |
| Section 8 | Pre-billing |
| Section 9 | Medical services provided to relatives [REVOKED] |
| Section 10 | Sales tax |
| Section 11 | Timely filing limitation |
| Section 11.1 | Resolution of claim payment |
| Section 12 | Credits and adjustments |
| Section 13 | Advance directives |
| Section 14 | Freedom of choice |
| Section 15 | Record retention |
| Section 16 | Release of medical records |
| Section 17 | Discrimination laws |
| Section 18 | Criminal penalties |
| Section 19 | Administrative sanctions [REVOKED] |
| Section 19.1 | Revocation of enrollment and billing privileges in the Medicaid Program [REVOKED] |
| Section 19.2 | Denial of application for new or renewed provider enrollment contract based on criminal history [EXPIRED] |
| Section 19.3 | Denial of application for new or renewed provider enrollment contract |
| Section 19.4 | Application fee, provider screening, and applicants subject to a fingerprint-based criminal background check |
| Section 19.5 | Termination of provider agreements |
| Section 19.6 | Complaints related to the Defunding Statutory Rape Cover-up Act |
| Section 20 | Claim inquiry procedures (excluding nursing homes and hospitals) |
| Section 20.1 | Pharmacy grievance procedures and processes [REVOKED] |
| Section 21 | Appeals procedures for nursing facilities |
| Section 22 | Hospital reimbursement rate appeals [REVOKED] |
| Section 23 | Reconsideration request |
| Section 24 | Third party liability |
| Section 25 | Crossovers (coinsurance and deductible) |
| Section 26 | Medicare Physician Payment Reform methodology [REVOKED] |
| Section 27 | Telehealth [AMENDED] |
| Section 27.1 | Audio-only health service delivery [NEW] |
| Section 28 | Oklahoma Electronic Health Records Incentive Program |
| Section 29 | Revisions of provider fee schedules |
| Section 30 | Signature requirements |
| Section 31 | Prior authorization for health care-related goods and services |
| Section 32 | Retrospective review for payment for services to certain aliens |
| Section 33 | Suspended claims review and/or prepayment review |
| Section 34 | Electronic visit verification (EVV) system |
| Section 35 | Oklahoma Statewide Health Information Exchange (OKSHINE) [AMENDED] |
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.
