Oklahoma Administrative Code › Title 365 - Insurance Department › Chapter 10 - Life, Accident and Health › Subchapter 1 - General Provisions › Part 3 - STANDARDIZED HEALTH CLAIM FORMS › Section 365:10-1-31 - Definitions

Current through Vol. 41, No. 20, July 1, 2024
The following words or terms, when used in this Part, shall
					 have the following meaning, unless the context clearly indicates
					 otherwise:
"ADA-1990 Dental Claim Form"
means the uniform
					 dental claim form approved by the American Dental Association for use by
					 dentists.
"CDT-1 Codes"
means the current dental
					 terminology, and its successors, required by the American Dental
					 Association.
"CPT-4 Codes"
means the current procedural
					 terminology published by the American Medical Association.
"HCFA"
means the federal Health Care Financing
					 Administration of the United States Department of Health and Human
					 Services.
"HCFA Form 1491"
means the health insurance
					 claim form and its electronic successor or equivalent published by HCFA for use
					 by health care practitioners to be used in filing claims for transportation
					 and/or ambulance services.
"HCFA Form 1500"
means the health insurance
					 claims form and its electronic successor or equivalent published by HCFA for
					 use by health care practitioners.
"HCFA Form UB-82"
means the health insurance
					 claim form and its electronic successor or equivalent published by HCFA for use
					 by hospitals.
"HCFA Form UB-92"
means the health insurance
					 claim form and its electronic successor or equivalent published by HCFA for use
					 by hospitals.
"HCPCS"
means HCFA's current common procedure
					 coding system.
"Health care practitioner"
means:
(A) a chiropractor licensed under 59 O.S. §
										161.1 et
					 seq.,
(B) a corporation or partnership of health care
					 practitioners as defined in this section and licensed under 59 O.S. §
										510,
(C) a dentist licensed under 59 O.S. §
										328.60
					 et seq.,
(D) a nurse licensed under 59 O.S. §
										567.1 et
					 seq.,
(E) a certified registered nurse anesthetist licensed under
					 59 O.S. §
										567.51,
(F) a nurse-midwife licensed under 59 O.S. §
										577.1 et
					 seq.,
(G) an ophthalmologist licensed under 59 O.S. §
										481
					 et seq.,
(H) an optometrist licensed under 59 O.S. §
										581
					 et seq.,
(I) a physician licensed under 59 O.S. §
										481
					 et seq.,
(J) a podiatrist licensed under 59 O.S. §
										135.1 et
					 seq.,
(K) a psychologist licensed under 59 O.S. §
										1351 et
					 seq.,
(L) therapists:
(i) a speech therapist licensed under 59 O.S. §
										1601 et
					 seq.,
(ii) a physical therapist licensed under 59 §887.1 et
					 seq.,
(iii) an occupational therapist licensed under 59 O.S.
					 §
										888.1 et
					 seq.
(M) an osteopath licensed under 59 O.S. §
										620 et
					 seq.,
(N) a licensed social worker under 59 O.S. §
										1261.1
					 et seq.,
(O) a licensed professional counselor licensed under 59
					 O.S. §
										1901 et
					 seq.
"Hospital"
means a hospital as defined in 63
					 O.S. §§
										1-701.
"ICD-10 Codes"
means the current disease codes
					 in the international classification of diseases published by the United States
					 Department of Health and Human Services.
"Third party payor"
means a person that
					 administers or provides reimbursement for health care benefits on an expense
					 incurred basis including:
(A) Health Maintenance Organization issued a certificate of
					 authority in accordance with 63 O.S. §
										2501, et
					 seq.,
(B) health insurer or nonprofit health service plan
					 authorized to offer health insurance policies or contracts in this State in
					 accordance with 36 O.S. §
										2601,
					 et seq., or
(C) third party administrator registered under 36 O.S.
					 §
										1441 et
					 seq.
Added at 11 Ok Reg
					 3295, eff 7-1-94; Amended at 29 Ok Reg 1254, eff
					 7-14-12