OAR 836-053-1335: Procedures for Complaint Investigation

(1) The Director of the Department of Consumer and Business Services may audit, examine and conduct an on-site review of records to investigate complaints alleging that an independent review organization or medical reviewer committed conduct contrary to ORS 743B.253 or 743B.256, or OAR 836-053-1300 to 836-053-1365 or the contract between the director and the independent review organization. (2) In addition to the procedures for an enrollee to submit information about an independent review organization’s decision in OAR 836-053-1325, a person, including, but not limited to, an enrollee, insurer or provider, may submit a written complaint to the director alleging that an independent review organization committed conduct described in this rule. The director may consider the complaint in relation to the terms of the contract with the independent review organization and in relation to ORS 743B.253 or 743B.256 and OAR 836-053-1300 to 836-053-1365 and take action as appropriate under the contract. The director shall notify the complainant of the results of the director's determinations and of any action taken or to be taken.