# Okla. Stat. tit. 36, § 36-6570.3: Adverse determinations to be made by physician or

> Oklahoma · Statutes · In force

URL: https://www.frixlaw.com/law-library/statutes/STATE_OK_T36_S36-6570.3

## Section

- **Citation:** Okla. Stat. tit. 36, § 36-6570.3
- **Heading:** Adverse determinations to be made by physician or
- **Jurisdiction:** Oklahoma
- **Kind:** Statutes
- **Status:** In force
- **Text as of:** August 14, 2026
- **Source:** Compiled text
- **Location:** OK Code / Title 36 / Section 36-6570.3

## Text

licensed mental health professional.

A utilization review entity shall ensure that all adverse

determinations are made by a physician or licensed mental health

professional. The physician or licensed mental health professional

shall:

1. Possess a current and valid nonrestricted license in any

United States jurisdiction;

2. Have the appropriate training, knowledge, or expertise to

apply appropriate clinical guidelines to the health care service

being requested; and

3. Make the adverse determination under the clinical direction

of one of the utilization review entity's medical directors who is

responsible for the provision of reviewing health care services to

enrollees of Oklahoma. All such medical directors must be

physicians licensed in any United States jurisdiction.

## Nearby sections

- [Okla. Stat. tit. 36, § 36-101 Short title](https://www.frixlaw.com/law-library/statutes/STATE_OK_T36_S36-101.md)
- [Okla. Stat. tit. 36, § 36-102 "Insurance" defined](https://www.frixlaw.com/law-library/statutes/STATE_OK_T36_S36-102.md)
- [Okla. Stat. tit. 36, § 36-115 Particular provisions prevail](https://www.frixlaw.com/law-library/statutes/STATE_OK_T36_S36-115.md)
- [Okla. Stat. tit. 36, § 36-305.1 Delinquency proceedings; appointment of personnel;](https://www.frixlaw.com/law-library/statutes/STATE_OK_T36_S36-305.1.md)
- [Okla. Stat. tit. 36, § 36-306.1 Availability of data necessary for review –](https://www.frixlaw.com/law-library/statutes/STATE_OK_T36_S36-306.1.md)
- [Okla. Stat. tit. 36, § 36-307.1 Rules and regulations](https://www.frixlaw.com/law-library/statutes/STATE_OK_T36_S36-307.1.md)
- [Okla. Stat. tit. 36, § 36-307.3 State Insurance Commissioner Revolving Fund](https://www.frixlaw.com/law-library/statutes/STATE_OK_T36_S36-307.3.md)
- [Okla. Stat. tit. 36, § 36-307.4 Use of grant - Audited annually](https://www.frixlaw.com/law-library/statutes/STATE_OK_T36_S36-307.4.md)
- [Okla. Stat. tit. 36, § 36-307.5 Insurance Department Anti-Fraud Revolving Fund](https://www.frixlaw.com/law-library/statutes/STATE_OK_T36_S36-307.5.md)
- [Okla. Stat. tit. 36, § 36-309.3 Appointment of examiner - Compliance with examiner's](https://www.frixlaw.com/law-library/statutes/STATE_OK_T36_S36-309.3.md)
- [Okla. Stat. tit. 36, § 36-309.7 Liability](https://www.frixlaw.com/law-library/statutes/STATE_OK_T36_S36-309.7.md)
- [Okla. Stat. tit. 36, § 36-310A.1 Reporting of material acquisitions and disposition of](https://www.frixlaw.com/law-library/statutes/STATE_OK_T36_S36-310A.1.md)
- [Okla. Stat. tit. 36, § 36-310A.2 Material acquisitions or dispositions defined -](https://www.frixlaw.com/law-library/statutes/STATE_OK_T36_S36-310A.2.md)
- [Okla. Stat. tit. 36, § 36-311A.5 Contents of annual audited financial report](https://www.frixlaw.com/law-library/statutes/STATE_OK_T36_S36-311A.5.md)

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Source: Frix Law Library, https://www.frixlaw.com/law-library/statutes/STATE_OK_T36_S36-6570.3. Check the current official text before relying on it. Not legal advice.