Oregon § 743B.420 Prior authorization requirements

Oregon Statutes

§ 743B.420 — Prior authorization requirements

Oregon § 743B.420

Vol.18

Title 56Insurance

Ch. 743BHealth Benefit Plans: Individual and Group

This text of Oregon § 743B.420 (Prior authorization requirements) is published on Counsel Stack Legal Research, covering Oregon primary law. Counsel Stack provides free access to over 12 million legal documents including statutes, case law, regulations, and constitutions.

Bluebook

Or. Rev. Stat. § 743B.420 (2026).

Text

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 60 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.

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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 60 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.