Skip to main content

Call the helpline at 800-987-7767, option 5, and talk to choice counselors to change your SoonerSelect health plan!

OHCA Policies and Rules

OHCA Policies and Rules Main Page

317:30-5-40.1. General information

[Revised 11-26-18]

(a) This Chapter applies to coverage in an inpatient and/or outpatient setting. Coverage is the same for adults and children unless otherwise indicated.

(b)  Professional Services.  Payment is made to a participating hospital group or corporation for hospital based physician's services. The hospital must have a Hospital Group Physician's Contract with OHCA for this method of billing.

(c) Prior Authorization.  OHCA requires prior authorization for certain procedures to validate the medical need for the service.

(d) Medical necessity.  Medical necessity requirements are listed at OAC 317:30-3-1(f) and 317:30-5-20.

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.

Back to top

Oklahoma Health Care Authority

4345 N Lincoln Blvd

Oklahoma City, OK 73105

Contact Us

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.