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OK SB1611
Bill
Status
2/6/2012
Primary Sponsor
Eddie Fields
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AI Summary
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Directs the Oklahoma Health Care Authority to implement waste, fraud, and abuse detection and prevention technologies to shift from retrospective "pay and chase" model to prospective pre-payment reviews.
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Requires implementation of provider data verification systems to screen for deceased providers, sanctioned providers, expired licenses, and incorrect addresses.
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Mandates state-of-the-art clinical code editing and predictive analytics technologies to identify billing errors and high-risk fraudulent patterns before claims are paid.
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Establishes contractor selection process through request for information and request for proposals, with contracts exempt from Oklahoma Central Purchasing Act; requires shared savings model where state costs tied to actual savings achieved.
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Requires reporting to legislative leadership and public on implementation results, savings achieved, impact on beneficiary access and quality of care, and provider effects within three months after each of first three implementation years.
Legislative Description
Medicaid; directing the Oklahoma Health Care Authority to implement technologies to address waste, fraud and abuse. Effective date.
Medicare and Medicaid
Last Action
Referred to Appr/Sub-Health and Human Services
2/9/2012