OAR 836-011-0600
Report on Services Provided by Expanded Practice Dental Hygienists

(1)

As used in this rule:

(a)

“Expanded practice dental hygienist” has the meaning given in ORS 679.010 (Definitions).

(b)

“Health insurer” includes:

(A)

An insurer authorized to transact health insurance in Oregon;

(B)

A health care service contractor as defined in ORS 750.005 (Definitions);

(C)

A multiple employer welfare arrangement as defined in ORS 750.301 (Definitions for ORS 750.301 to 750.341);

(D)

A coordinated care organization as defined in ORS 414.025 (Definitions for ORS chapters 411, 413 and 414), or a dental care organization or governed by the Oregon Health Authority;

(E)

A third party administrator licensed under ORS 744.702 (Third party administrator license); and

(F)

Federally qualified health centers governed by the United States Department of Health and Human Services.

(2)

A health insurer authorized to transact health insurance that provides coverage for dental services in Oregon shall, by August 1 of every even-numbered year, report to the Department of Consumer and Business Services information pertaining to reimbursement for those dental services provided by Expanded Practice Dental Hygienists (EPDH) to Oregon residents for the 24-month period ending June 30 of the reporting year. For each dental service provided during the period under review the information shall include:

(a)

The Current Dental Terminology code denoting the type of service provided;

(b)

The provider’s National Provider Identifier number; and

(c)

The following information, which the department will aggregate prior to providing the information to the Board of Dentistry:

(A)

The amount billed by the EPDH to the insurer for the service provided;

(B)

The amount allowed for the service under the insurance plan;

(C)

The amount of benefit paid by the insurer for the dental service (i.e. the amount of the benefit subtracting any deductible, copay, coinsurance or other cost-sharing);

(D)

The amount owed by the insured for the service (i.e. deductible, copay, coinsurance or other cost-sharing);

(E)

The amount of excluded charges owed by the insured; and

(F)

The amount of excluded charges, if any, that the provider is not allowed to collect from the insured due to their provider agreement with the insurer.

(3)

A health insurer subject to this rule shall provide the report required in section (2) of this rule electronically, as requested by the Director.

Source: Rule 836-011-0600 — Report on Services Provided by Expanded Practice Dental Hygienists, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=836-011-0600.

836‑011‑0000
Annual Statement Blank and Instructions 836‑011‑0015
Property and Casualty Actuarial Opinion of Reserves and Supporting Documentation 836‑011‑0020
Definitions 836‑011‑0022
Filing Procedures 836‑011‑0024
Contents of Corporate Governance Annual Disclosure 836‑011‑0030
Own Risk and Solvency Assessment 836‑011‑0050
Requirements for Segregation of Premium Received for Coverage Not Eligible for Federal Subsidies 836‑011‑0100
Authority 836‑011‑0110
Definitions 836‑011‑0120
Filing and Extensions for Filing of Annual Audited Financial Reports 836‑011‑0130
Exemptions 836‑011‑0140
Contents of Annual Audited Financial Report 836‑011‑0150
Designation of Independent Certified Public Accountant 836‑011‑0160
Qualifications of Independent Certified Public Accountant 836‑011‑0170
Consolidated or Combined Audits 836‑011‑0180
Scope of Audit and Report of Independent Certified Public Accountant 836‑011‑0190
Notification of Adverse Financial Condition 836‑011‑0200
Communication of Internal Control Related Matters Noted in an Audit 836‑011‑0210
Accountant’s Letter of Qualifications 836‑011‑0220
Definition, Availability and Maintenance of Independent Certified Public Accountants Workpapers 836‑011‑0223
Requirements for Audit Committee 836‑011‑0224
Internal Audit Function Requirements 836‑011‑0225
Conduct of Insurer in Connection with the Preparation of Required Reports and Documents 836‑011‑0227
Management’s Report of Internal Control over Financial Reporting 836‑011‑0230
Canadian and British Companies 836‑011‑0235
Effective Dates 836‑011‑0250
Authority 836‑011‑0253
Definitions 836‑011‑0255
Reserve Adequacy 836‑011‑0258
Unallocated Reserve Account 836‑011‑0260
Distribution of Annual Financial Statement 836‑011‑0300
Statutory Authority 836‑011‑0305
Definitions 836‑011‑0310
RBC Reports 836‑011‑0320
Company Action Level Event 836‑011‑0330
Regulatory Action Level Event 836‑011‑0340
Authorized Control Level Event 836‑011‑0350
Mandatory Control Level Event 836‑011‑0360
Hearings 836‑011‑0380
Supplemental Provisions 836‑011‑0390
Foreign Insurers 836‑011‑0430
Scope and Authority 836‑011‑0440
Report 836‑011‑0450
Acquisitions and Dispositions of Assets 836‑011‑0460
Nonrenewals, Cancellations or Revisions of Ceded Reinsurance Agreements 836‑011‑0500
Application 836‑011‑0505
Definitions 836‑011‑0510
RBC Reports 836‑011‑0515
Company Action Level Event 836‑011‑0520
Regulatory Action Level Event 836‑011‑0525
Authorized Control Level Event 836‑011‑0530
Mandatory Control Level Event 836‑011‑0535
Hearings 836‑011‑0540
Supplemental Provisions 836‑011‑0545
Foreign Health Care Service Contractors 836‑011‑0600
Report on Services Provided by Expanded Practice Dental Hygienists
Last Updated

Jun. 8, 2021

Rule 836-011-0600’s source at or​.us