Utilization Review Licensing in Oklahoma

Application for Registration as an Independent Review Organization

$0

• A copy of the most recent certificate from American Accreditation HealthCare Commission/URAC for Independent Review Organizations
• A schedule of fees
• A copy of the current Certificate of Authority provided by the Oklahoma Secretary of State

Application for Registration as an Independent Review Organization (Renewal)

$0

Biennially by December 31. The first renewal is due by December 31 of the calendar year following approval.

Independent Review Organization External Review Annual Report

$0

Annually by January 31.

OAC 365:10-29-10

Utilization Review Certification and/or Registration Application

Applicants must use the online SERFF system to apply.

$500

• List of all other office locations
• Copy of the utilization review plan
• List of the type and qualifications of the personnel either employed or under contract to perform the utilization review
• Procedures and policies in place to ensure that a representative of the private review agent is reasonably accessible
• Policies and procedures in place to ensure that all applicable State and Federal laws to protect the confidentiality of individual medical records are followed
• Policies and procedures in place to verify and identity the authority of personnel performing utilization review by telephone
• A copy of all materials designed to inform applicable patients and health care providers of the requirements of the utilization review plan
• A list of the third party payers for which the private review agent is performing utilization review in this state. Said list may be deemed confidential by the Commissioner for the purpose of protecting competition between agents
• Procedures in place for handling complaints by patients and health care providers concerning utilization review
• Procedures in place to ensure that after a request for medical evaluation, treatment, or procedures has been rejected in whole or in part and in the event a copy of the report on said rejection is requested, a copy of the report of the private review agent concerning the rejection shall be mailed by the insurer, postage prepaid, to the ill or injured person, the treating healthcare provider, or to the person financially responsible for the patient’s bill within fifteen (15) days after the receipt of the request for the report

Utilization Review Certification and/or Registration Annual Renewal Application

Applicants must use the online SERFF system to renew.

$500

Annually by the anniversary of initial registration.