Or. Admin. Code § 836-053-1425 - Definitions for behavioral health benefits reporting
As used in these rules:
(1) "Behavioral health benefits" means
insurance coverage of mental health treatment and services and substance use
disorder treatment and services.
(2) "Geographic region" means the regions
identified as the specific geographic divisions for Oregon's individual and
small group market as required by OAR
836-053-0465.
(3) "Incentive payment" means any
compensation arrangement, including but not limited to coordination fees,
withholds, bonuses, capitation, or any other compensation, to pay a provider or
provider group directly or indirectly.
(4) "Median maximum allowable reimbursement
rate" means the median of all maximum allowable reimbursement rates, minus
incentive payments, paid for each billing code for each provider type during a
calendar year.
(5) "Partial denial"
means the denial and non-reimbursement of portions of a medical claim submitted
for services or supplies provided to a covered enrollee as specified in the
plan documents.
(6) "Time-based
office visit" means an in-person office or telehealth visit between a health
care provider and a patient in specific increments as determined by the
relevant CPT billing code.
Notes
Statutory/Other Authority: Or Laws 2021, ch 629
Statutes/Other Implemented: Or Laws 2021, ch 629
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