Relating to in-network credentialing; and prescribing an effective date.

Provider payments protected during network approval

Beginning September 26, 2025, Oregon requires covered insurers to pay for covered care while providers seek network approval. This applies to managed health insurance and preferred provider plans, but excludes health maintenance organizations. Insurers must approve or reject complete applications within 90 days. A complete application includes required information, proof of a recognized professional license, required liability coverage, and federal drug registration when applicable. The payment period starts when the insurer receives a complete application and ends at its decision or 90 days, whichever comes first. Insurers may generally pay out-of-network rates during this period. But providers joining an in-network group must receive in-network rates on the same payment schedule as in-network providers. If the provider fails to submit a complete application or meet approval requirements, the group must repay the rate difference. Insurers must notify providers within 90 days of receipt if an application is incomplete. Providers can file claims during or after the review period; claims filed within six months afterward cannot be denied as late. Insurers need not pay under these rules when they previously rejected or removed the provider for objectively verified substandard care. That exception requires a chance to challenge the decision before peers under federal health care quality review law. The law sets provider payment rules, not new patient copay or deductible amounts.