1. (1) An insurer shall accept a properly completed claim submitted on the applicable uniform form prescribed by the exhibits to this rule, or on the substantially identical respective form approved by the American Medical Association’s Council on Medical Services or the American Dental Association’s Council on Dental Care Programs, as follows:

   1. (a) Exhibit 1 — For claims other than dental care claims;
   2. (b) Exhibit 2 — For dental care claims.
2. (2) If the information entered on the form is incomplete, the insurer may return the form to the provider for completion to the extent necessary.
3. (3) If additional information is essential to the insurer’s proper handling of the claim, it may seek such information by letter, investigative inquiry, or other reasonable means of communication. These inquiries shall be kept to a minimum and shall not seek information duplicating what already is known to the insurer.

4. (4) An insurer may, at its option, accept a claim form different from the uniform form prescribed by this rule.

   [ED. NOTE: Exhibits referenced are available from the agency.]

Statutory/Other Authority

ORS 731.244 & 743.028

Statutes/Other Implemented

ORS 743.028

History

ID 1-1995, f. 4-26-95, cert. ef. 8-1-95
IC 75, f. & ef. 5-27-77
IC 73, f. 2-25-77, ef. 3-1-77