ORS 743B.445: 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.