™Your Policy Risk Impact Agent
17 chapters · 1,565 sections in this title.
ORS 735.546 Pharmacy claims audits; auditors
0.4K chars
An entity that contracts with an independent third party to conduct audits may not: (1) Agree to compensate the independent third party based on a percentage of the amount of overpayments recovered; or (2) Disclose information obtained during an audit except to the contracting en…
ORS 735.548 Pharmacy claims audits; validation of claims
1.0K chars
For purposes of ORS 735.540 to 735.552, an entity, or an independent third party that contracts with an entity to conduct audits, must allow as evidence of validation of a claim: (1) An electronic or physical copy of a prescription that complies with ORS chapter 689 if the prescr…
ORS 735.550 Pharmacy claims audits; reports of findings; opportunity to resubmit claim and to contest finding
2.1K chars
(1)(a) After conducting an audit, an entity must provide the pharmacy that is the subject of the audit with a preliminary report of the audit. The preliminary report must be received by the pharmacy no later than 45 days after the date on which the audit was completed and must be…
ORS 735.552 Pharmacy claims audits; exception for fraud
0.6K chars
ORS 735.540 to 735.552 do not: (1) Preclude an entity from instituting an action for fraud against a pharmacy; (2) Apply to an audit of pharmacy records when fraud or other intentional and willful misrepresentation is evidenced by physical review, review of claims data or stateme…