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OKDHS Home > Library > Policy > OAC 317 > Chapter 30. Medical Providers-Fee for Service > 3. General Provider Policies > 6. Utilization review for physician/hospital services
317:30-3-6. Utilization review for physician/hospital services
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Revised 7-25-08

 

   The Surveillance and Utilization Review System (SURS) is used to help identify patterns of inappropriate care and services.

  • (1) Use of this system enables OHCA to develop a comprehensive profile of any aberrant pattern of practice and reveals suspected instances of fraud or abuse in the SoonerCare Program.  Also, the Utilization Review program is a useful tool in detecting the existence of any potential defects in the level of care or service provided under the SoonerCare Program.
  • (2) OHCA contracts with a Quality Improvement Organization (QIO) to review the length of stay and appropriateness of hospital admissions.  Unresolved patterns of non-compliance with medical criteria for admissions, outpatient procedures and length of stay will be referred to OHCA.

 
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Last Updated:  8/15/2008
Oklahoma Department of Human Services
Street address: Sequoyah Memorial Office Building, 2400 N. Lincoln Blvd., Oklahoma City, OK 73105
Mailing address: P.O. Box 25352, Oklahoma City, OK 73125
(405) 521-3646
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