2021 Oregon Revised Statutes
Chapter 743B - Health Benefit Plans: Individual and Group
Section 743B.502 - Third party contracts for leasing of provider panels; requirements.

(a) The third party contract is specifically authorized by the provider network contract; and
(b) The third party contract obligates the third party to comply with all applicable terms, limitations and conditions of the provider network contract.
(2) A contracting entity that provides access to the health care services and discounted rates of a provider under a provider network contract shall:
(a) Give to the provider in writing or electronically, at the time a provider network contract is entered into, a list of all third parties known by the contracting entity at the time to which the contracting entity has or will provide access to the health care services and discounted rates of a provider under the provider network contract;
(b) Maintain an Internet website, toll-free telephone number or other readily available mechanism through which a provider may obtain a list, updated at least every 90 days, of all third parties that have access to the provider’s health care services and discounted rates under the provider network contract;
(c) Provide each third party listed under paragraph (a) or (b) of this subsection with information necessary to enable the third party to comply with all relevant terms, limitations and conditions of the provider network contract;
(d) Require a third party to identify on each remittance or explanation of payment sent to a provider the source of any contractual discount in rates taken by the third party under the provider network contract; and
(e)(A) Notify each third party listed under paragraph (a) or (b) of this subsection of the termination of the provider network contract no later than 30 days prior to the effective date of the termination; and
(B) Require third parties to cease claiming entitlement to discounted rates or other rights under a provider network contract after the termination of the contract.
(3) The notice required under subsection (2)(e)(A) of this section can be provided by any reasonable means, including but not limited to written notice, electronic communication or an update to an electronic database.
(4) Subject to any applicable continuity of care requirements, agreements or contractual provisions:
(a) A third party’s right to access a provider’s health care services and discounted rates under a provider network contract shall terminate on the date the provider network contract is terminated;
(b) Claims for health care services performed after the termination date of the provider network contract are not eligible for processing and payment in accordance with the provider network contract; and
(c) Claims for health care services performed before the termination date of the provider network contract, but processed after the termination date, are eligible for processing and payment in accordance with the provider network contract.
(5)(a) All information made available to a provider in accordance with the requirements of this section and ORS 743B.503 shall be confidential and may not be disclosed to any person not involved in the provider’s practice or the administration thereof without the prior written consent of the contracting entity.
(b) This section and ORS 743B.503 may not be construed to prohibit a contracting entity from requiring a provider to execute a reasonable confidentiality agreement to ensure that confidential or proprietary information disclosed by the contracting entity is not used for any purpose other than the provider’s direct practice management or billing activities. [Formerly 743.085]
Note: See note under 743B.500.

Structure 2021 Oregon Revised Statutes