Okla. Admin. Code § 310:657-7-6

Current through Vol. 42, No. 6, December 2, 2024

Section 310:657-7-6 - Dispute resolution procedures

(a) The Plan shall have procedures for dispute resolution on issues related to medical care under the Plan. This procedure may be different than the grievance procedure for resolving matters not directly related to medical care under the Plan. A dispute resolution procedure shall be available to the injured worker and to the attending or ordering provider.

(b) The Plan's procedure shall be designed to resolve each dispute within ten (10) days after receipt, unless information is not available in the normal course of business.

(c) Each dispute shall be evaluated by an appropriate peer or another licensed health professional as mutually agreed by the parties. The evaluating professional shall not have been involved in the initial decision to deny a service.

(d) The Plan shall notify the injured worker and affected provider of its decision.

(e) An injury requiring emergency services shall be treated immediately, without regard for the ten (10) day dispute resolution period.

Okla. Admin. Code § 310:657-7-6

Added at 12 Ok Reg 2977, eff 6-16-95 (emergency); Added at 13 Ok Reg 2127, eff 6-13-96; Amended at 14 Ok Reg 2264, eff 6-12-97; Amended at 23 Ok Reg 2404, eff 6-25-06