Library: Policy

317:30-5-576. Eligible providers

Issued 6-25-11

(a) General requirements.  To be an eligible clinic provider, a clinic must be under the direction of a physician who is on the premises and who is a SoonerCare enrolled provider.  In addition, the supervising physician must meet any other applicable licensure or certification required by State law or meet Medicare certification for participation.  All clinic providers must have a current contract with the Oklahoma Health Care Authority (OHCA).  The OHCA will review all clinic contracts to ensure compliance with all OHCA requirements, as well as all State and Federal laws.  The OHCA has discretion and the final authority to approve or deny any provider contract.

(b) National Provider Identification (NPI).  The clinic must have an organizational NPI number and each individual licensed physician and licensed non-physician practitioner must have an individual NPI and meet the provider qualification requirements applicable to the same service when it is furnished in other settings.

(c) Written patient care policies.  A clinic under this Part must establish, in writing:

• (1) a description of health services provided by the clinic;

• (2) policies concerning the medical management of health problems including health conditions which require referral to physicians and provision of emergency health services; and

• (3) policies concerning the maintenance and review of health records by the physician or dentist.