1. (1) Billings for medical services under an MCO must be submitted in the form and format as prescribed in OAR 436-009. The payment of medical services may be less than, but must not exceed, the maximum amounts allowed under OAR 436-009.
   (2) Notwithstanding section (1) of this rule, fees paid for medical services provided by come-along providers must not be less than fees paid to MCO panel providers for similar medical services.
   (3) Payments to medical providers who are not under contract with the MCO are not subject to an MCO discount.

Statutory/Other Authority

ORS 656.260 & 656.726(4)

Statutes/Other Implemented

ORS 656.260 & ORS 656.245

History

WCD 5-2018, amend filed 03/15/2018, effective 04/01/2018
WCD 7-2013, f. 11-12-13, cert. ef. 1-1-14
WCD 3-2010, f. 5-28-10, cert. ef. 7-1-10
WCD 6-2004, f. 6-14-04, cert. ef. 6-29-04
WCD 14-2003(Temp), f. 12-15-03, cert. ef. 1-1-04 thru 6-28-03
WCD 12-1998, f. 12-16-98, cert. ef. 1-1-99
WCD 13-1996, f. 5-6-96, cert. ef. 6-1-96
WCD 14-1994, f. 12-20-94, cert. ef. 2-1-95
WCD 2-1992, f. 1-10-92, cert. ef. 2-1-92
WCD 33-1990, f. 12-12-90, cert. ef. 12-26-90
WCD 11-1990(Temp), f. 6-19-90, cert. ef. 7-1-90