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.

Health and Social Services

https://olis.oregonlegislature.gov/liz/2025R1/Measures/Overview/HB3242