Description of patient protection reports
- Health insurers in Oregon must file an annual report on their ability to promptly resolve consumer complaints. The report identifies a number of grievance categories, reports how many decisions are upheld or reversed, and at what level of appeal those complaints are resolved.
Utilization Review - Those insurers that require pre-authorization for treatment are required to file an annual summary relating to the insurer's utilization review policies. The report includes information on how utilization decisions are made, the timeliness of completing reviews, and how utilization review criteria is developed and revised. Supplemental reports, including work plans, evaluations, and review statistics may also be included with their reporting.
Network Adequacy - Managed care organizations must file an annual report on the scope and adequacy of their provider network. The report includes the insurer's ongoing monitoring that all covered services are reasonably accessible to enrollees.
Quality Assessment - Managed care organizations must file an annual quality assessment report on their ability to identify and achieve relevant quality improvement goals. This allows insurers to evaluate, maintain, and improve the quality of health services provided to enrollees. Insurers may provide supplemental reports related to their quality assessment review, including their goals, work plans, and evaluations.