Or. Admin. Code § 836-080-0080

Current through Register Vol. 63, No. 10, October 1, 2024

Section 836-080-0080 - Definition, Claims Handling Services; Claims Procedures and Information

(1) As used in sections 2 and 3, chapter 747, Oregon Laws 2001, "clean claim" means a claim under a health benefit plan that has no defect, impropriety, lack of any required substantiating documentation or particular circumstance requiring special treatment that prevents timely payment.

(2) For purposes of section 2(1), chapter 747, Oregon Laws 2001, an insurer is considered to have received a claim when the claim is received by the insurer itself or when the claim is received by a representative of the insurer that performs claims handling on the sole behalf of the insurer, whichever receipt date is earlier. A representative may include but is not limited to a third party administrator, a claims service or a pricing service. When an insurer uses such a representative, then the insurer shall include for purposes of section 2(1), chapter 747, Oregon Laws 2001, the days in which a claim is in the control of the representative, including the date on which the representative received the claim.

(3) For the purpose of communicating the information necessary for claim form completion as required by section 2(3), chapter 747, Oregon Laws 2001, an insurer shall include any specific description of standard supporting documentation, information and data routinely required to be submitted with a claim form. Compliance with the standard transaction requirements established under the federal Health Insurance Portability and Accountability Act at 45 CFR parts 160 and 162 shall be considered to be compliance with this section.

Or. Admin. Code § 836-080-0080

ID 1-2002, f. & cert. ef. 1-15-02

Stat. Auth.: ORS 731.244; Sec. 2, Ch. 747, OL 2001

Stats. Implemented: Sec. 2, Ch. 747, OL 2001