Health Benefit Plans: Individual and Group

ORS 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 30 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. [Formerly 743.837]

Source

Last accessed
Jun. 26, 2021