Library: Policy

340:75-13-63. Prior authorization and claims procedures for medical services

Revised 9-14-24

        Prior authorization is required for medical services, per Oklahoma Administrative Code (OAC) 317:30-3-82.  Procedures and guidelines for prior authorization are outlined in OAC 317:30-3-82, available to all healthcare providers at  www.oklahoma.gov/ohca.

(1) Contact Oklahoma Health Care Authority (OHCA).  For services, supplies, or equipment requiring prior authorization, the healthcare provider contacts the OHCA-contracted agency for specific instructions and assistance.

(2) Contact Child Welfare Services (CWS) Finance and Business (FB).  When CWS staff or placement providers are referred to a collection agency for nonpayment of a medical bill for a child in Oklahoma Human Services custody, CWS staff contacts CWS FB for guidance regarding payment procedures.  Any medical payments made from state funds are paid at rates no greater than established Oklahoma Medicaid rates.