An HMO or its employees and agents shall not:
- (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) Compel a subscriber or provider to:
- (A) Accept less than the full settlement of a claim; or
- (B) File suit to obtain full settlement; or
- (3) Knowingly misrepresent reimbursement criteria or time limits to a subscriber, provider, or their representatives.
Added at 21 Ok Reg 77, eff 11-1-03 (emergency)
Added at 21 Ok Reg 1672, eff 7-14-04