- (a) The Plan shall complete any individual decision to authorize or deny a non-emergency service within two (2) working days after obtaining all necessary information. Necessary information includes any clinical evaluation of an injured worker by a provider other than the one originally recommending a proposed service.
- (b) The Plan shall notify the provider by telephone within twenty-four (24) hours after the decision to authorize or deny a service. The Plan shall send confirmation of the decision within two (2) working days after deciding.
- (c) If the injured worker is an inpatient or undergoing treatment, the Plan shall communicate to the provider any decision to authorize or deny the service by telephone within twenty-four (24) hours after the decision. The Plan shall send confirmation to the provider within two (2) working days after deciding. A decision on an extended stay shall identify the additional number of days or services approved.
- (d) A decision to authorize or deny coverage for an emergency service shall be based on the patient's presenting symptoms.
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