Oregon Statutes 743B.450 – Prompt payment of claims; limits on use of electronic payment methods; rules
(1) Except as provided in this subsection, when a claim under a health benefit plan is submitted to an insurer by a provider on behalf of an enrollee, the insurer shall pay a clean claim or deny the claim not later than 30 days after the date on which the insurer receives the claim. If an insurer requires additional information before payment of a claim, not later than 30 days after the date on which the insurer receives the claim, the insurer shall notify the enrollee and the provider in writing and give the enrollee and the provider an explanation of the additional information needed to process the claim. The insurer shall pay a clean claim or deny the claim not later than 30 days after the date on which the insurer receives the additional information.
Terms Used In Oregon Statutes 743B.450
- Contract: A legal written agreement that becomes binding when signed.
- Electronic funds transfer: The transfer of money between accounts by consumer electronic systems-such as automated teller machines (ATMs) and electronic payment of bills-rather than by check or cash. (Wire transfers, checks, drafts, and paper instruments do not fall into this category.) Source: OCC
(2) A contract between an insurer and a provider may not include a provision governing payment of claims that limits the rights and remedies available to a provider under this section and ORS § 743B.452 or has the effect of relieving either party of its obligations under this section and ORS § 743B.452.
(3) An insurer may pay a claim using a credit card or electronic funds transfer payment method that imposes on the provider a fee or similar charge to process the payment if:
(a) The insurer notifies the provider, in advance, of the fee or other charges associated with the use of the credit card or electronic funds transfer payment method;
(b) The insurer offers the provider an alternative payment method that does not impose fees or similar charges on the provider; and
(c) The provider or a designee of the provider elects to accept a payment of the claim using the payment method.
(4) An insurer shall establish a method of communicating to providers the procedures and information necessary to complete claim forms. The procedures and information must be reasonably accessible to providers.
(5) This section does not create an assignment of payment to a provider.
(6) Each insurer shall report to the Director of the Department of Consumer and Business Services on its compliance under this section according to requirements established by the director.
(7) The director shall adopt by rule a definition of ‘clean claim’ and shall consider the definition of ‘clean claim’ used by the federal Department of Health and Human Services for the payment of Medicare claims. [Formerly 743.911]