Oklahoma § 36-7302 - Dental insurance plans - Contracting entity requirements

§ 36-7302. Dental insurance plans - Contracting entity requirements

A. As used in this section:

1. "Contracting entity" means any person or entity that is

engaged in the act of contracting with providers for the delivery of

dental services or the selling or assigning of dental plans to other

dental care entities;

2. "Identify" means providing in writing, by email or

otherwise, to the participating provider the name, address and

telephone number, to the extent possible, for any third party to

which the contracting entity has granted access to the dental

services of the participating provider;

3. "Network plan" means dental plans offered by a health

insurance issuer under which the financing and delivery of dental

services are provided in whole or in part through a defined set of

participating providers under contract with the health insurance

issuer;

4. "Participating provider" means a provider who, under a

contract with a contracting entity, has agreed to provide dental

services with an expectation of receiving payment, other than

Oklahoma Statutes - Title 36. Insurance

coinsurance, copayments or deductibles, directly or indirectly, from

the contracting entity; and

5. "Provider" means any person licensed by the Board of

Dentistry pursuant to the provisions of Section 328.21 of Title 59

of the Oklahoma Statutes.

B. A contracting entity shall not sell, assign or otherwise

grant access to the dental services of a participating provider

under any health care contract unless expressly authorized by the

health care contract. The health care contract shall specifically

provide that one purpose of the contract is the selling, assigning

or giving the contracting entity rights to the services of the

participating provider, including network plans.

C. Upon entering a contract with a participating provider and

upon request by a participating provider, a contracting entity shall

properly identify any third party that has been granted access to

the dental services of the participating provider.

D. A contracting entity that sells, assigns or otherwise grants

access to the dental services of a participating provider shall

maintain an Internet website or a toll-free telephone number through

which the participating provider may obtain information which

identifies the insurance carrier to be used to reimburse the

participating provider for the covered dental services.

E. A contracting entity that sells, assigns or otherwise grants

access to a participating provider's dental services shall ensure

that an explanation of benefits or remittance advice furnished to

the participating provider that delivers dental services under the

health care contract identifies the contractual source of any

applicable discount.

F. All third parties that have contracted with a contracting

entity to purchase, be assigned or otherwise be granted access to

the participating provider's discounted rate shall comply with the

participating provider's contract, including all requirements to

encourage access to the participating provider, and pay the

participating provider pursuant to the rates of payment and

methodology set forth in that contract, unless otherwise agreed to

by a participating provider.

G. A contracting entity is deemed in compliance with this

section when the insured's identification card provides information

which identifies the insurance carrier to be used to reimburse the

participating provider for the covered dental services.

Added by Laws 2016, c. 126, § 1, eff. Nov. 1, 2016.