OK SB1553

Amends Oklahoma Medicaid law to require that appeals of adverse claim determinations be reviewed by a licensed physician, psychologist, or mental health professional—prohibiting the use of automated claim review software for appeals

Requires appeal reviewers to hold an unrestricted license in any U.S. jurisdiction and have the same or similar specialty as providers who typically treat the condition in question

Mandates that appeal reviewers have no direct involvement in the original adverse determination and no financial interest in the appeal outcome

Allows psychologists and mental health providers to recover costs from the contracted entity for time and expenses related to appeals if the adverse determination is reversed through a fair hearing

Effective date: November 1, 2026