Oregon Administrative Rules › Chapter 836 - DEPARTMENT OF CONSUMER AND BUSINESS SERVICES, INSURANCE REGULATION › Division 53 - HEALTH BENEFIT PLANS › Section 836-053-0350 - Provider Directory Requirements for Network Adequacy

Current through Register Vol. 63, No. 7, July 1, 2024
(1)
(a) An
			 insurer shall post electronically a current, accurate and complete provider
			 directory for each of its network plans with the information and search
			 functions, as described in section (2) of this rule.
(b) In making the directory available
			 electronically, the insurer shall ensure that the general public is able to
			 view all of the current providers for a plan through a clearly identifiable
			 link or tab and without creating or accessing an account or entering a policy
			 or contract number.
(c)
(A) An insurer shall update each network plan
			 provider directory at least monthly. The provider directory shall disclose the
			 frequency with which it is updated.
(B) The insurer shall include a disclosure in
			 the directory that the information included in the directory is accurate as of
			 the date posted to the web or printed and that enrollees or prospective
			 enrollees should consult the insurer to obtain current provider directory
			 information.
(d) An
			 insurer shall provide a print copy, or a print copy of the requested directory
			 information, of a current provider directory with the information described in
			 section (2) of this rule upon request of an enrollee or a prospective enrollee.
(e) For each network plan, an
			 insurer shall include in plain language in both the electronic and print
			 directory, the following general information:
(A) A description of the criteria the insurer
			 has used to build its provider network;
(B) If applicable, a description of the
			 criteria the insurer has used to tier providers;
(C) If applicable, information about how the
			 insurer designates the different provider tiers or levels in the network and
			 identifies for each specific provider, hospital, or other type of facility in
			 the network which tier each is placed, for example by name, symbols or
			 grouping, in order for an enrollee or a prospective enrollee to be able to
			 identify the provider tier; and
(D)
			 If applicable, note that authorization or referral may be required to access
			 some providers.
(f)
(A) An insurer shall make it clear in both
			 its electronic and print directories which provider directory applies to which
			 network plan, such as including the specific name of the network plan as
			 marketed and issued in this state.
(B) The insurer shall include in both its
			 electronic and print directories a customer service email address and telephone
			 number or electronic link that enrollees or the general public may use to
			 notify the insurer of inaccurate provider directory information.
(g) For the pieces of
			 information required under this section in a provider directory pertaining to a
			 health care professional, a hospital or a facility other than a hospital, the
			 insurer shall make available through the directory a general explanation of the
			 source of the information and any limitations, if applicable.
(h) A provider directory, whether in
			 electronic or print format, shall accommodate the communication needs of
			 individuals with disabilities, and include a link to or information regarding
			 available assistance for persons with limited English proficiency.