Application programming interface; requirements. (1) An insurer offering a health benefit plan in this state that provides utilization review or has utilization review provided on the insurer’s behalf shall utilize a prior authorization application programming interface as described in 45 C.F.R. 156.223(b), as in effect on February 28, 2024. The application programming interface shall enable a provider to

(a) Determine whether prior authorization is required;

(b) Identify the information and documentation necessary to submit the request; and

(c) Transfer prior authorization requests and determinations from the provider’s electronic health records or practice management system through a secure electronic transmission.

(2) An insurer shall respond through the application programming interface described in subsection (1) of this section to a request that was submitted by a provider through the application programming interface. [2025 c.388 §3]

Note: 743B.445 becomes operative January 1, 2027. See section 12, chapter 388, Oregon Laws 2025.

Note: 743B.445 was added to and made a part of the Insurance Code by legislative action but was not added to ORS chapter 743B or any series therein. See Preface to Oregon Revised Statutes for further explanation.

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