1. (a) No person may operate a Plan in Oklahoma, nor use the phrase "workplace medical plan," nor imply that it is a workplace medical plan, unless that person first obtains a certificate.
2. (b) No Plan shall imply that certification qualifies the Plan to provide services except as authorized under the Act and OAC 310:657.

3. (c) A Plan, its employees and agents shall not:

   1. (1) Pay claims reviewers based on reductions, unless the reductions are based on uniformly applied protocols designed to detect billing errors and duplicate charges;

   2. (2) Compel an injured worker or a provider to:

      1. (A) Accept less than the full settlement of a claim;
      2. (B) File suit to obtain full settlement;
      3. (C) Accept a lesser, interim figure as a premature final settlement; or
   3. (3) Knowingly misrepresent reimbursement criteria and time frames to employees, a provider, an insurer, an insured, or their representatives.

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