Get Application For Registration As An Independent Review ... - Ok . Gov - Ok 2016-2025

This guide provides clear, step-by-step instructions for completing the application for registration as an independent review organization. Whether you are a seasoned professional or new to the process, this guide is designed to support you in successfully filling out the necessary form.

Follow the steps to fill out the application effectively.

1. Press the ‘Get Form’ button to access the application form and open it for editing.
2. Begin by selecting the type of entity you are registering. Options include Corporation, Partnership, LLC, or Other. Ensure that you select the correct type, as this will impact the requirements.
3. Provide the legal name of the applicant. Ensure that this is the official name registered with relevant authorities.
4. Input the state of domicile and the federal EIN (Employer Identification Number). Both fields are essential for verifying your entity's registration.
5. Fill out the contact person’s details, including name, title, phone number, and email address. Make sure the contact information is accurate to facilitate communication.
6. Provide the business address. Do not use a P.O. Box. Ensure that this address is where your organization operates.
7. If the mailing address is different from the business address, provide the alternate mailing information in the required fields.
8. Complete the contact information for initiating external reviews. This information should include a contact person or department, phone number, email, mailing address, and toll-free telephone number.
9. Review the applicant attestation and certification section. You will need to certify your understanding of the requirements and responsibilities outlined within the application.
10. Sign the application. Both the person completing the application and an officer, director, or board member must sign. Include printed names, titles, and dates for each signature.
11. Prepare any required attachments listed in the application, including organizational descriptions, conflict of interest disclosures, recent accreditation certificates, fee schedules, and policies.
12. Submit the application and all attachments to the Oklahoma Insurance Department at the specified address.
13. After submission, ensure to save any changes made to the form. You may also want to download or print a copy for your records.

Begin filling out your application online today to ensure your registration as an independent review organization!