Current through Register Vol. 63, No. 9, September 1, 2024
(1) "Electronic
transaction" means to conduct a transaction:
(a) Through the use of a computer program or
an electronic or other automated means independently to initiate an action or
respond to electronic records or performances in whole or in part, without
review or action by an individual; or
(b) Through the use of a web portal or the
internet.
(2)
(a) "Health care entity" includes:
(A) A health care service contractor as
required under ORS 750.055;
(B) A multiple employer welfare arrangement
as required under ORS
750.333;
(C) A prepaid managed care health services
organization as defined in ORS
414.736;
(D) Any entity licensed as a third party
administrator under ORS
744.702;
(E) Any person or public body that either
individually or jointly established a self-insurance plan, program or contract,
including but not limited to persons and public bodies that are otherwise
exempt from the Insurance Code under ORS
731.036;
(F) A health care clearinghouse or other
entity that processes or facilitates the processing of health care financial
and administrative transactions from a nonstandard format to a standard format;
and
(G) Any other person identified
by the department that processes health care financial and administrative
transactions between a health care provider and an entity described in this
subsection.
(b) "Health
care entity" does not include a pharmacy or a pharmacy benefits
manager.
(3) "Health
insurer" means any insurer authorized to transact health insurance in
Oregon.
(4) "Oregon Companion
Guide" means one of the compilations of uniform standards adopted by the
Department of Consumer and Business Services and posted on the Oregon Insurance
Division's website that provide standards for health care financial and
administrative transactions. The following Oregon Companion Guides are
applicable to respective transactions with health insurers and health care
entities in Oregon:
(a) Oregon Companion Guide
for the Implementation of the ASC X12N/005010X279 Health Care Eligibility
Benefit Inquiry and Response (270/271).
(b) The Oregon Companion Guide for the
Implementation of the EDI Transaction: ASC X12/005010X222 Health Care Claim:
Professional (837).
(c) The Oregon
Companion Guide for the Implementation of the EDI Transaction: ASC
X12/005010X223 Health Care Claim: Institutional (837).
(d) The Oregon Companion Guide for the
Implementation of the EDI Transaction: ASC X12/005010X224 Health Care Claim:
Dental (837).
(5)
"Oregon Companion Guide Oversight Committee" means the committee appointed
jointly by the Department of Consumer and Business Services and the Oregon
Health Authority to carry out the responsibilities under OAR
836-100-0120.
(6) "Provider" means a health care provider
that provides health care or medical services within Oregon for a fee and is
eligible for reimbursement for these services.
Stat. Auth.: ORS
731.244 & 2011 OL Ch. 130
Sec. 2 (Enrolled SB 94)
Stats. Implemented: 2011 OL Ch. 130 Sec. 2 (Enrolled SB 94)
