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Library: Policy

317:30-3-20. Claim inquiry procedures (excluding nursing homes and hospitals)

Revised 9-14-20

A medical provider may request a review of the amount paid or the non-payment of medical services provided to an eligible member. If the medical provider does not agree with the adjudication of the original claim, he/she may submit an electronic request for review on the Oklahoma Health Care Authority (OHCA) provider portal in accordance with the instructions in the Provider Billing and Procedures Manual, available on OHCA's website, Documentation, including but not limited to, supporting medical documentation and/or proof of timely filing as outlined in Oklahoma Administrative Code (OAC) 317:30-3-11, must be included with each submission.

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