Oklahoma § 36-6570.6 - Time frame to make prior authorization or adverse

§ 36-6570.6. Time frame to make prior authorization or adverse

determination.

A. If a utilization review entity requires prior authorization

of a health care service, the utilization review entity must make a

prior authorization or adverse determination and notify the enrollee

and the enrollee's health care provider of the prior authorization

or adverse determination in accordance with the time frames set

forth below:

Oklahoma Statutes - Title 36. Insurance

1. For purposes of approving prior authorization for urgent

health care services, within seventy-two (72) hours of obtaining all

necessary information to make the prior authorization or adverse

determination; or

2. For purposes of approving prior authorization for non-urgent

health care services, within seven (7) days of obtaining all

necessary information to make the prior authorization or adverse

determination.

For purposes of this section, "necessary information" includes,

but is not limited to, the results of any face-to-face clinical

evaluation or second opinion that may be required.

B. For those health care providers that submit all necessary

information through the utilization review entity's authorized prior

authorization system, health care services are deemed authorized if

a utilization review entity fails to comply with the deadlines set

forth in this section.

C. In the notification to the health care provider that a prior

authorization has been approved, the utilization review entity shall

include in such notification the duration of the prior authorization

or the date by which the prior authorization will expire.

Added by Laws 2024, c. 303, § 7, eff. Jan. 1, 2025.