Okla. Admin. Code § 365:10-15-3

Current through Vol. 42, No. 7, December 16, 2024

Section 365:10-15-3 - Private review agent certification and renewal

(a) A private review agent shall not perform utilization review unless the Insurance Commissioner has granted the private review agent a certificate.

(b) A certificate to perform utilization review as a private agent expires on the anniversary of its effective date, unless renewed by the Insurance Commissioner. If the renewal application is received by the Oklahoma Insurance Department after 5:00 p.m. on the day of expiration it will not be accepted and the Five Hundred Dollar ($500.00) renewal fee shall not be returned. Once a private review agent's certificate has expired, the private review agent may not perform utilization review until such time as the private review agent has applied for and received a new certificate from the Insurance Commissioner. The application for a new certificate shall require submission of the $500.00 certification fee as well as the filing of all exhibits which are required to be filed with an original certificate application.

(c) In order to prevent its certificate from automatically expiring, a private review agent must submit the following information to the Insurance Commissioner prior to the anniversary of the certificate's effective date: a $500.00 renewal fee; a renewal application; and satisfactory evidence of compliance with any specific requirement made by the Insurance Commissioner for renewal of such certificate.

(d) If the fees and documentation set forth in the prior paragraph are submitted to the Insurance Commissioner prior to the anniversary of the certificate's effective date, the Insurance Commissioner shall not refuse to renew the certificate without providing the certificate holder reasonable time to supply additional information demonstrating compliance with the Hospital and Medical Services Utilization Review Act and the opportunity to request a hearing.

Okla. Admin. Code § 365:10-15-3

Added at 14 Ok Reg 2957, eff 7-14-97