Oklahoma § 63-5051.2 - Right to reimbursement for medical services Assignment to Oklahoma Health Care Authority

§ 63-5051.2. Right to reimbursement for medical services Assignment to Oklahoma Health Care Authority

A. Whenever the Oklahoma Health Care Authority pays for medical

services or renders medical services, for or on behalf of a person

who has been injured or suffered an illness or disease, the right of

the provider of the services to reimbursement shall be automatically

assigned to the Oklahoma Health Care Authority, upon notice to the

insurer or other party obligated as a matter of law or agreement to

reimburse the provider on behalf of the patient.

B. Upon the assignment, the Authority, for purposes of the

claim for reimbursement, becomes a provider of medical services.

C. The assignment of the right to reimbursement shall be

applied and considered valid against any employer or insurer under

the Administrative Workers’ Compensation Act in this state.

D. Each insurer, upon receiving a claim from the Oklahoma

Health Care Authority, shall accept the state’s right of recovery,

to process and, if appropriate, pay the claim to the same extent

that the plan would have been liable if it had been billed at the

point of sale or by the original provider of services. The insurer

shall not deny the Authority claims on the basis of the date of

submission, the format of the claim, or for failure to present

proper documentation of coverage at the point of sale.

E. An insurer or third-party administrator, except a Medicare

Advantage plan, shall not deny the Authority claims solely on the

basis that a claimed item or service did not receive prior

authorization under the rules or coverage policies of the insurer or

third-party administrator. The insurer or third-party administrator

shall accept an authorization provided by the Authority for an item

or service covered under the state Medicaid program or under a homeand community-based services waiver for such individual as if such

authorization was made by the insurer or third-party administrator

for such item or service.

F. If the Authority submits an inquiry regarding a claim to an

insurer or third-party administrator not later than three (3) years

after the date of provision of the claimed item or service, the

insurer or third-party administrator shall respond to the inquiry

within sixty (60) days of receiving the inquiry.

G. An insurer shall make appropriate payments to the Authority

as long as the claim is submitted for consideration within three (3)

Oklahoma Statutes - Title 63. Public Health and Safety

years from the date the service was furnished. Any action by the

Authority to enforce the payment of the claim shall be commenced

within six (6) years of the submission of the claim by the

Authority.

Added by Laws 1981, c. 159, § 2, emerg. eff. May 8, 1981. Amended

by Laws 1996, c. 221, § 2, eff. Nov. 1, 1996. Renumbered from §

200a of Title 56 by Laws 1996, c. 221, § 6, eff. Nov. 1, 1996.

Amended by Laws 2007, c. 74, § 2, eff. Nov. 1, 2007; Laws 2024, c.

449, § 1, emerg. eff. June 14, 2024.