State Law

Oregon Admin. Rules-Insurance Regulation-Chapter 836-Division 53. Health Benefit Plans

08/20/2023 Oregon Section 836-053-1610

Non-anesthesia-related claims

OON-Payment Issues

(1) Out-of-network reimbursement for non-anesthesia-related claims shall be no less than:

Base rate x Modifier adjustment x CPI adjustment

(2) Out-of-network reimbursement for a non-anesthesia-related claim that does not have a base rate listed on the Non-Anesthesia Fee Schedule shall be at a rate agreed upon in good faith by the insurer and the provider to be usual and customary for in-network commercial claims, using best efforts to establish a rate within a reasonable amount of time.