Oklahoma § 63-5051.5 - Data files comparisons - File systems maintained by

§ 63-5051.5. Data files comparisons - File systems maintained by

insurers - Exchange of information with Authority.

Oklahoma Statutes - Title 63. Public Health and Safety

A. 1. On or after November 1, 2003, any entity that provides

health insurance in this state including, but not limited to, a

licensed insurance company, not-for-profit hospital service, medical

indemnity corporation, managed care organization, self-insured plan,

pharmacy benefit manager or other party that is, by statute,

contract, or agreement, legally responsible for payment of a claim

for a health care item or service is hereby required to compare data

from its files with data in files provided to the entity by the

Oklahoma Health Care Authority and accept the Authority’s right of

recovery and the assignment of rights and not charge the Authority

or any of its authorized agents any fees for the processing of

claims or eligibility requests. Data files requested by or provided

to the Authority shall provide the Authority with eligibility and

coverage information that will enable the Authority to determine the

existence of third party coverage for Medicaid recipients and the

necessary information to determine during what period Medicaid

recipients may be or may have been covered by the health insurer and

the nature of the coverage that is or was provided, including the

name, address, and identifying number of the plan.

2. The insurer shall transmit to the Authority, in a manner

prescribed by the Centers for Medicare and Medicaid Services or as

agreed between insurer and the Authority, an electronic file of all

identified subscribers or policyholders, or their dependents, for

whom there is data corresponding to the information contained in

subsection C of this section.

B. 1. An insurer shall comply with a request under the

provisions of this subsection no later than sixty (60) days after

the date of transmission by the Authority and shall only be required

to provide the Authority with the information required by subsection

C of this section.

2. The Authority may make such request for data from an insurer

no more than once every six (6) months, as determined by the date of

the Authority’s original request.

C. Each insurer shall maintain a file system containing the

name, address, group policy number, coverage type, social security

number, and date of birth of each subscriber or policyholder, and

each dependent of the subscriber or policyholder covered by the

insurer, including policy effective and termination dates, claim

submission address, and employer’s mailing address.

D. The Oklahoma Health Care Authority Board shall promulgate

rules governing the exchange of information under this section.

Such rules shall be consistent with all laws relating to the

confidentiality or privacy of personal information or medical

records including, but not limited to, provisions under the federal

Health Insurance Portability and Accountability Act (HIPAA).

Oklahoma Statutes - Title 63. Public Health and Safety

Added by Laws 2003, c. 464, § 12, eff. July 1, 2003. Amended by

Laws 2007, c. 74, § 3, eff. Nov. 1, 2007; Laws 2011, c. 204, § 1,

eff. Nov. 1, 2011.