Bill > HB3242

This bill modifies Oregon's laws regarding in-network credentialing for health insurers by clarifying and expanding provisions for healthcare provider applications and claims payments. The bill adds definitions for "in-network" and "out-of-network" to existing law and introduces a new requirement for health insurers when a healthcare provider joins an already in-network provider group. Specifically, if a provider is joining an in-network group, the health insurer must pay all claims during the credentialing period at the same rate and payment schedule as in-network providers. If the provider's application is incomplete or fails to meet credentialing requirements, the provider group must reimburse the insurer for the difference between in-network and out-of-network rates. The bill maintains existing rules that require health insurers to approve or reject a complete provider application within 90 days and allows providers to submit claims for medical services during the credentialing period. The bill also preserves exceptions to claims payment in cases where a provider was previously terminated for objectively verifiable professional standards violations. The legislation is set to take effect on the 91st day after the adjournment of the 2025 regular legislative session.