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STATE OF OKLAHOMA
2nd Session of the 58th Legislature (2022)
HOUSE BILL 3023 By: Worthen
AS INTRODUCED
An Act relating to dental insurance claims; defining
terms; making certain requir ements; providing
standards for requirem ents; providing for
codification; and providing an ef fective date.
BE IT ENACTED BY THE PEOPLE OF THE STATE OF OKLAHOMA:
SECTION 1. NEW LAW A new section of law to be codified
in the Oklahoma Statutes as Section 7500 of Title 36, unless there
is created a duplication in num bering, reads as follows:
A. As used in this section :
1. "Bundling" means the practice of combining disti nct dental
procedures into one procedure for billing purposes;
2. "Covered services" means services covered by the dental
plan;
3. "Dental plan" means and shall include any policy of
insurance which is issued by a health benefit plan which provides
for coverage of dental services not in connection with a medical
plan;
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4. "Downcoding" means the adjustment of a cl aim submitted to a
dental plan to a less complex or lower cost procedure code; and
5. "Health benefit plan " means any plan or arrangement as
defined in subsection C of Section 6060.4 of Title 36 of the
Oklahoma Statutes or any dental service corporation a uthorized
pursuant to Section 2671 of Title 36 of the Oklahoma Statutes;
6. "Material change" means a change to the following:
a. a dental plan's rules, guidelines, policies, or
procedures concerning payment for de ntal services,
b. the general practices of the dental plan that aff ect
reimbursements paid to providers, or
c. how a dental plan adjudicate s and pays claims for
services.
B. An insurer that contracts or renews a contract with a dental
provider shall:
1. Make the insurer's current dental plan po licies available
online; and
2. If requested by a provider, send a copy o f the policies to
the provider through mail or electronic mail.
C. Dental policies and plans as described in subsection B of
this section shall provide the following to providers:
1. A summary of all material changes made to a dental plan
since the policies were last updated;
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2. The downcoding and bundling policies that the insurer
reasonably expects to be applied to the dental provider or
provider's services as a matter of pol icy; and
3. A description of the dental plan's utilization review
procedures, including:
a. a procedure for an enrollee of the dental plan to
obtain a review of an adverse determination, and
b. a statement of a provider 's rights and
responsibilities reg arding the procedures described in
subparagraph a of this paragraph.
D. An insurer may not maintain a dental plan that:
1. Based on the provider's contracted fee for covered
services, uses downcoding in a manner tha t prevents a dental
provider from collecting the fee for actual services perfor med
either from the plan or the patient; or
2. Uses bundling in a manner where a procedure code is labeled
as nonbillable to the pati ent unless, under generally accepted
practice standards, the procedure code is for a pro cedure that may
be provided in conjunction with another procedure .
E. An insurer shall ensure that an explanation of benefits for
a dental plan includes the reason for any downcoding or bundling
result.
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SECTION 2. This act shall become e ffective November 1, 2022.
58-2-9023 KN 01/05/22