OAR 436-015-0090: Charges and Fees

Edition: Current OARD snapshotEffective: 2018-04-01Last verified: 2026-09-07

(1) Billings for medical services under an MCO must be submitted in the form and format as prescribed in OAR 436-009. The payment of medical services may be less than, but must not exceed, the maximum amounts allowed under OAR 436-009. (2) Notwithstanding section (1) of this rule, fees paid for medical services provided by come-along providers must not be less than fees paid to MCO panel providers for similar medical services. (3) Payments to medical providers who are not under contract with the MCO are not subject to an MCO discount.

Official history and status

Statutory/Other Authority: ORS 656.260 & 656.726(4)

Statutes/Other Implemented: ORS 656.260 & ORS 656.245

History: WCD 5-2018, amend filed 03/15/2018, effective 04/01/2018 WCD 7-2013, f. 11-12-13, cert. ef. 1-1-14 WCD 3-2010, f. 5-28-10, cert. ef. 7-1-10 WCD 6-2004, f. 6-14-04, cert. ef. 6-29-04 WCD 14-2003(Temp), f. 12-15-03, cert. ef. 1-1-04 thru 6-28-03 WCD 12-1998, f. 12-16-98, cert. ef. 1-1-99 WCD 13-1996, f. 5-6-96, cert. ef. 6-1-96 WCD 14-1994, f. 12-20-94, cert. ef. 2-1-95 WCD 2-1992, f. 1-10-92, cert. ef. 2-1-92 WCD 33-1990, f. 12-12-90, cert. ef. 12-26-90 WCD 11-1990(Temp), f. 6-19-90, cert. ef. 7-1-90

This rule cites

section (1) of this rule — target_record_not_published

Cited by

OAR 436-015-0070: Temporary rule language in effect until 10/04/2026. Come-along Providers

Official source: https://secure.sos.state.or.us/oard/