Oregon HB4028 regulates audits of behavioral health claims by insurers and coordinated care organizations.

Oregon HB4028 imposes restrictions on how insurers and coordinated care organizations audit behavioral health claims. Insurers must ensure that nonquantitative treatment limitations on behavioral health benefits are comparable to those on medical and surgical benefits. Audits must be completed within 180 days, and insurers must provide providers with a detailed description of any errors and allow a 30-day window to rectify them. Insurers cannot demand recoupment unless they have notified providers of new requirements at least 30 days in advance.

Oregon HB4028 regulates audits of behavioral health claims by insurers and coordinated care organizations.

Oregon HB4028 imposes restrictions on how insurers and coordinated care organizations audit behavioral health claims. Insurers must ensure that nonquantitative treatment limitations on behavioral health benefits are comparable to those on medical and surgical benefits. Audits must be completed within 180 days, and insurers must provide providers with a detailed description of any errors and allow a 30-day window to rectify them. Insurers cannot demand recoupment unless they have notified providers of new requirements at least 30 days in advance.