PART 1. General Scope And Administration

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.