Oklahoma § 74-1328 - Reimbursement of claims within certain time period

§ 74-1328. Reimbursement of claims within certain time period

A. The contracted claims administrator for the Oklahoma Health

Care Authority shall reimburse all clean claims of an enrollee, an

assignee of the enrollee, or a health care provider within fortyfive (45) calendar days after receipt of the claim by the entity.

B. As used in this section, "clean claim" means a claim that

has no defect or impropriety, including a lack of any required

substantiating documentation, or particular circumstance requiring

special treatment that impedes prompt payment.

C. 1. If a claim or any portion of a claim is determined to

have defects or improprieties, including a lack of any required

substantiating documentation, or a particular circumstance requiring

special treatment, the enrollee, assignee of the enrollee, or health

care provider shall be notified in writing within thirty (30)

calendar days after receipt of the claim by the contracted claims

administrator for the Authority. The written notice shall specify

the portion of the claim that is causing a delay in processing and

explain any additional information or corrections needed. Failure

of the Authority's claims administrator to provide the enrollee,

assignee of the enrollee, or health care provider with such notice

shall constitute prima facie evidence that the claim will be paid in

accordance with the terms of the health benefit claims

administration contract.

2. The portion of the claim that is accurate shall be paid

within forty-five (45) calendar days after receipt of the claim by

the claims administrator for the Authority.

D. Upon receipt of the additional information or corrections

which led to the claim's being delayed and a determination that the

Oklahoma Statutes - Title 74. State Government

information is accurate, the claims administrator for the Authority

shall either pay or deny the claim or a portion of the claim within

forty-five (45) calendar days.

E. Payment shall be considered made on:

1. The date a draft or other valid instrument which is

equivalent to the amount of the payment is placed in the United

States mail in a properly addressed, postpaid envelope; or

2. If not so posted, the date of delivery.

F. An overdue payment shall bear simple interest at the rate of

ten percent (10%) per year.

G. In the event litigation should ensue based upon such a

claim, the prevailing party shall be entitled to recover a

reasonable attorney fee to be set by the court and taxed as costs

against the party or parties who do not prevail.

Added by Laws 2001, c. 65, § 3, eff. Nov. 1, 2001. Amended by Laws

2002, c. 155, § 1, eff. July 1, 2002; Laws 2012, c. 304, § 972; Laws

2025, c. 379, § 35, eff. Nov. 1, 2025.