Oregon Statutes 743.029 – Uniform standards for health care financial and administrative transactions; rules
(1) The Department of Consumer and Business Services may adopt by rule uniform standards applicable to persons listed in subsection (2) of this section for health care financial and administrative transactions, including uniform standards for:
Terms Used In Oregon Statutes 743.029
- 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
- Person: includes individuals, corporations, associations, firms, partnerships, limited liability companies and joint stock companies. See Oregon Statutes 174.100
- public body: means state government bodies, local government bodies and special government bodies. See Oregon Statutes 174.109
(a) Eligibility inquiry and response;
(b) Claim submission;
(c) Payment remittance advice;
(d) Claims payment or electronic funds transfer;
(e) Claims status inquiry and response;
(f) Claims attachments;
(g) Prior authorization;
(h) Provider credentialing; or
(i) Health care financial and administrative transactions identified by the stakeholder work group described in ORS § 743.031.
(2) Any uniform standards adopted under subsection (1) of this section apply to:
(a) Health insurers.
(b) Prepaid managed care health services organizations as defined in ORS § 414.025.
(c) Coordinated care organizations as defined in ORS § 414.025.
(d) Third party administrators.
(e) Any person or public body that either individually or jointly establishes a self-insurance plan, program or contract, including but not limited to persons and public bodies that are otherwise exempt from the Insurance Code under ORS § 731.036.
(f) Health care clearinghouses or other entities that process or facilitate the processing of health care financial and administrative transactions from a nonstandard format to a standard format.
(g) Any other person identified by the department that processes health care financial and administrative transactions between a health care provider and an entity described in this subsection.
(3) In developing or updating any uniform standards adopted under subsection (1) of this section, the department shall consider recommendations from the Oregon Health Authority under ORS § 743.031. [Formerly 743.061]
743.029 was added to and made a part of the Insurance Code by legislative action but was not added to ORS Chapter 743 or any series therein. See Preface to Oregon Revised Statutes for further explanation.
[Formerly 739.420; renumbered 743.044 in 2015]