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83rd OREGON LEGISLATIVE ASSEMBLY--2025 Regular Session
A-Engrossed
House Bill 3242
Ordered by the House March 4
Including House Amendments dated March 4
Sponsored by Representative DIEHL; Representatives HARBICK, JAVADI, MCINTIRE (Presession filed.)
SUMMARY
The following summary is not prepared by the sponsors of the measure and is not a part of the body thereof subject
to consideration by the Legislative Assembly. It is an editor’s brief statement of the essential features of the
measure. The statement includes a measure digest written in compliance with applicable readability standards.
Digest: This Act tells a health insurer to pay a health care provider in the same way it
would pay them if they were in-network during a certain time and in some situations. Tells
the provider to pay back the money sometimes. Tells insurers to tell providers that their
application is incomplete in certain circumstances. (Flesch Readability Score: 61.6).
[Digest: This Act tells a health insurer to pay a health care provider in the same way it would pay
if they were in-network during a certain time and in some situations. (Flesch Readability Score:
63.4).]
Requires health insurers to pay providers who are joining an in-network practice the same as
in-network providers during the credentialing period. Requires repayment by the provider group
if the provider does not meet credentialing criteria or submit a complete application. Estab-
lishes a notification process of an incomplete application for the purpose of determining re-
payments.
Takes effect on the 91st day following adjournment sine die.
A BILL FOR AN ACT
Relating to in-network credentialing; amending ORS 743B.454; and prescribing an effective date.
Be It Enacted by the People of the State of Oregon:
SECTION 1. ORS 743B.454 is amended to read:
743B.454. (1) As used in this section:
(a) “Complete application” means a provider’s application to a health insurer to become a cre-
dentialed 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, the Long Term Care Administrators Board, the Board of Licensed Dietitians or the
Behavior Analysis Regulatory Board;
(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 ear-
lier.
(c) “Health insurer” means an insurer that offers managed health insurance or preferred pro-
vider organization insurance, other than a health maintenance organization as defined in ORS
750.005.
NOTE:Matter in boldfaced type in an amended section is new; matter [italic and bracketed] is existing law to be omitted.
New sections are in boldfaced type.
LC 1984 A-Eng. HB 3242
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(d) “In-network” has the meaning given that term in ORS 743B.280.
(e) “Out-of-network” has the meaning given that term in ORS 743B.280.
(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 pe-
riod:
(A) During or after the credentialing period.
(B) At the rate paid to nonparticipating providers.
(d) Notwithstanding paragraph (c) of this subsection, if the application is for a health
care provider joining a provider group that is in-network with the health insurer, the health
insurer shall pay all claims for medical services covered by the health insurer that are pro-
vided by the provider during the credentialing period at the same rate and according to the
same payment schedule as in-network providers. However, if the provider does not submit a
complete application or does not meet credentialing requirements, the provider group shall
reimburse the health insurer in an amount equal to the difference between in-network and
out-of-network rates. Within 90 days from the date the health insurer receives the applica-
tion, the health insurer, in complying with this paragraph, shall notify the provider that the
application is not a complete application.
[(d)] (e) 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.
SECTION 2. This 2025 Act takes effect on the 91st day after the date on which the 2025
regular session of the Eighty-third Legislative Assembly adjourns sine die.
[2]