ORS 735.544: Pharmacy claims audits; standards for review of claims.
Edition: 2025 EditionEffective: 2026-01-01Last verified: 2026-09-07
An entity’s finding that a claim was incorrectly presented or paid must be based on identified transactions and not based on probability sampling, extrapolation or other means that project an error using the number of patients served who have a similar diagnosis or the number of similar prescriptions or refills for similar drugs. [2013 c.570 §6]
Official history and status
History: Note: See note under 735.530.
Administrative rules citing this section
- OAR 836-200-0401: Statement of Purpose; Authority; Applicability — implements
- OAR 836-200-0421: Service on Licensee — implements
- OAR 836-200-0436: Submission of Complaints — implements
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Official source: https://www.oregonlegislature.gov/bills_laws/ors/ors735.html