Or. Admin. Code § 836-053-1342 - Timelines and Notice for Expedited Decision-Making

(1) When an insurer expedites an enrollee's case under ORS 743B.252(5), the insurer shall inform the Director of the Department of Consumer and Business Services and the independent review organization that the referral is expedited. If information on whether a referral is expedited is not provided to the independent review organization, the independent review organization may presume that the referral is not an expedited review, but the independent review organization may request clarification from the insurer.

(2) The insurer and the director must expedite an external review that is required to be expedited under ORS 743B.252(5) when:

(a) An enrollee requests external review before the enrollee has exhausted all internal appeals; or

(b) An enrollee simultaneously requests an expedited internal appeal and an expedited external review.

(3) An independent review organization shall make its decision in each expedited case within a time period that is appropriate for accommodating the clinical urgency of the particular case, but in any event not exceeding the maximum time period specified in ORS 743B.256(3).

(4) In an expedited case, an independent review organization shall immediately provide notice to enrollees and the insurer of the result and basis for the decision as provided in OAR 836-053-1325.

Notes

Or. Admin. Code § 836-053-1342

ID 10-2002(Temp), f. & cert. ef. 4-5-02 thru 9-27-02; ID 19-2002, f. 9-27-02, cert. ef. 9-28-02; ID 11-2011(Temp), f. & cert. ef. 7-7-11 thru 12-21-11; ID 23-2011, f. & cert. ef. 12-19-11; ID 12-2013, f. 12-31-13, cert. ef. 1-1-14; ID 24-2018, minor correction filed 08/22/2018, effective 8/22/2018

Statutory/Other Authority: ORS 731.244, ORS 743B.253 & ORS 743B.256

Statutes/Other Implemented: ORS 743B.253, ORS 743B.256 & ORS 743B.252