MEMO 2025-16 [REVISED]
DATE: September 23, 2025
October 27, 2025
TO: SOONERSELECT MEDICAL and CHILDREN’S SPECIALTY CONTRACTED ENTITIES
SUBJECT: Prior Authorization Timeliness (Alignment with HB1810)
PURPOSE:
The purpose of this Memo is to provide SoonerSelect Medical and Children’s Specialty Program (CSP) Contracted Entities (CEs) with updated guidance to ensure consistency with statutory requirements affecting prior authorization (PA) processes and timeliness.
BACKGROUND:
Current SoonerSelect Medical and CSP contracts outline the following service level agreements (SLAs) for prior authorization timeliness and exceptions:
- Processing timeliness for expedited PA requests shall be made as expeditiously as necessary and shall not exceed twenty-four (24) Hours after receipt of the request for service.
- Processing timeliness for standard PA requests shall not exceed seventy-two (72) hours following the receipt of the request of service.
- Refer to memo 2024-18 for extension processes for expedited and standard PA requests.
During the 2025 Oklahoma Legislative Session, House Bill 1810 (HB1810) was enacted, introducing new requirements for timeliness of PA processing, opportunities for extensions, and validity periods.
Consistent with HB1810 and 56 O.S. §4002.6, covered prescription drugs must receive a prior authorization or adverse determination within 24 hours of receiving all required information, and coverage for biomarker testing must be processed in accordance with Section 4003 of Title 56. [REVISED October 27, 2025]
Impacted SoonerSelect Medical and Children’s Specialty Program (CSP) Contract Sections include Section
1.8.6 Authorization Processes, 1.18.1 Overall Requirements, 1.18.6 Adverse Benefit Determinations, Appendix 1B Definitions, and Appendix 1E Liquidated Damages.
DECISION:
OHCA is updating SoonerSelect Medical and CSP contract language and reporting requirements to ensure compliance with HB1810. These updates are intended to ensure program operations and contractual obligations fully reflect statutory requirements that will be in effect November 1, 2025. The decisions outlined in this memo will supersede the decisions outlined in memo 2024-18 for dates of service on or after November 1, 2025.
Key Timeliness Standards:
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Expedited Requests: Must be processed as quickly as necessary, not to exceed 24 hours from receipt.
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Standard Requests: Must be processed within 72 hours of receipt.
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Prescription Drugs: PA or denial must be issued within 24 hours of receiving all required information.
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Biomarker Testing: Must follow Section 4003 of Title 56.