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Library: Policy

317:30-5-42.4. Clinic/treatment room services; urgent care

Issued 12-1-06

(a) An outpatient hospital clinic is a non-emergency service providing diagnostic, preventive, curative and rehabilitative services on a scheduled basis.

(b) Urgent care payment is made for services provided in non-emergency clinics operated by a hospital.  This payment does not include the professional charges of the treating physician, nurse practitioner, physician assistant or charges for diagnostic testing.  A facility charge is also allowed when drug and/or blood are administered outpatient.

(c) Urgent Care services will not require a referral for SoonerCare Choice members however other claims will deny without a referral.

(d) Adults are limited to four clinic visits per month.

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