(a) An HMO that fails to comply with the requirements in Titles 36 of the Oklahoma Statutes regarding reimbursement of claims and with this Part shall pay the greater of:
- (1) The penalty amount for late payment referred to in applicable provisions in Title 36 of the Oklahoma Statutes; or
- (2) The contracted penalty rate for late payment set forth in the contract between the provider and the HMO.
- (b) Failure to pay the correct amount on a clean claim in accordance with the contract or denial of a clean claim for which payment should have been made that results in a failure to comply with the requirements of applicable provisions in Title 36 of the Oklahoma Statutes and this Part is considered a violation and may be subject to administrative penalties as set forth in HMO Act.
- (c) Any amount previously paid or any charge for a non-covered service shall be deducted from the payment.
Added at 21 Ok Reg 77, eff 11-1-03 (emergency)
Added at 21 Ok Reg 1672, eff 7-14-04