ORS § 743B.420

Current through 2024 Regular Session legislation

Section 743B.420 - Prior authorization requirements

Except in the case of misrepresentation, prior authorization determinations shall be subject to the following requirements:

(1) Prior authorization determinations relating to benefit coverage and medical necessity shall be binding on the insurer if obtained no more than 60 days prior to the date the service is provided.

(2) Prior authorization determinations relating to enrollee eligibility shall be binding on the insurer if obtained no more than five business days prior to the date the service is provided.

ORS 743B.420

Amended by 2021 Ch. 154,§ 4, eff. 1/1/2022.

Formerly 743.837