Or. Admin. Code § 436-015-0090

Current through Register Vol. 63, No. 12, December 1, 2024

Section 436-015-0090 - Charges and Fees

(1) Billings for medical services under an MCO must be submitted in the form and format as prescribed in OAR 436-009. The payment of medical services may be less than, but must not exceed, the maximum amounts allowed under OAR 436-009.

(2) Notwithstanding section (1) of this rule, fees paid for medical services provided by come-along providers must not be less than fees paid to MCO panel providers for similar medical services.

(3) Payments to medical providers who are not under contract with the MCO are not subject to an MCO discount.

Or. Admin. Code § 436-015-0090

WCD 11-1990(Temp), f. 6-19-90, cert. ef. 7-1-90; WCD 33-1990, f. 12-12-90, cert. ef. 12-26-90; WCD 2-1992, f. 1-10-92, cert. ef. 2-1-92; WCD 14-1994, f. 12-20-94, cert. ef. 2-1-95; WCD 13-1996, f. 5-6-96, cert. ef. 6-1-96; WCD 12-1998, f. 12-16-98, cert. ef. 1-1-99; WCD 14-2003(Temp), f. 12-15-03, cert. ef. 1-1-04 thru 6-28-03; WCD 6-2004, f. 6-14-04, cert. ef. 6-29-04; WCD 3-2010, f. 5-28-10, cert. ef. 7-1-10; WCD 7-2013, f. 11-12-13, cert. ef. 1-1-14; WCD 5-2018, amend filed 03/15/2018, effective 4/1/2018

Statutory/Other Authority: ORS 656.260 & 656.726(4)

Statutes/Other Implemented: ORS 656.260 & ORS 656.245