75th OREGON LEGISLATIVE ASSEMBLY--2009 Regular Session
 
SA to SB 507
 
LC 1482/SB 507-5
 
                      SENATE AMENDMENTS TO
                         SENATE BILL 507
 
                      By COMMITTEE ON RULES
 
                             May 29
 
  On page 1 of the printed bill, delete lines 6 through 22 and
insert:
  '  { +  SECTION 2. + }  { +  (1) As used in this section:
  ' (a) 'Complete application' means a provider's application to
a health insurer to become a credentialed provider that includes:
  ' (A) Information required by the health insurer;
  ' (B) Proof that the provider is licensed by a health
professional regulatory board as defined in ORS 676.160;
  ' (C) Proof of current registration with the Drug Enforcement
Administration of the United States Department of Justice, if
applicable to the provider's practice; and
  ' (D) Proof that the provider is covered by a professional
liability insurance policy or certification meeting the health
insurer's requirements.
  ' (b) 'Credentialing period' means the period beginning on the
date a health insurer receives a complete application and ending
on the date the health insurer approves or rejects the complete
application or 90 days after the health insurer receives the
complete application, whichever is earlier.
  ' (c) 'Health insurer' means an insurer that offers managed
health insurance or preferred provider organization insurance,
other than a health maintenance organization as defined in ORS
750.005.
  ' (2) A health insurer shall approve or reject a complete
application within 90 days of receiving the application.
  ' (3)(a) A health insurer shall pay all claims for medical
services covered by the health insurer that are provided by a
provider during the credentialing period.
  ' (b) A provider may submit claims for medical services
provided during the credentialing period during or after the
credentialing period.
  ' (c) A health insurer may pay claims for medical services
provided during the credentialing period:
  ' (A) During or after the credentialing period.
  ' (B) At the rate paid to nonparticipating providers.
  ' (d) If a provider submits a claim for medical services
provided during the credentialing period within six months after
the end of the credentialing period, the health insurer may not
deny payment of the claim on the basis of the health insurer's
rules relating to timely claims submission.
  ' (4) Subsection (3) of this section does not require a health
insurer to pay claims for medical services provided during the
credentialing period if:
  ' (a) The provider was previously rejected or terminated as a
participating provider in any health benefit plan underwritten or
administered by the health insurer;
  ' (b) The rejection or termination was due to the objectively
verifiable failure of the provider to provide medical services
within the recognized standards of the provider's profession; and
 
  ' (c) The provider was given the opportunity to contest the
rejection or termination before a panel of peers in a proceeding
conducted in conformity with the Health Care Quality Improvement
Act of 1986, 42 U.S.C. 11101 et seq. + } ' .
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