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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
Section 4 Electronic fund transfer/direct deposit
Section 4.1 Uniform Electronic Transaction Act
Section 5 Assignment and cost sharing
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
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 State Health Information Network and Exchange (OKSHINE)

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.