Definitions for ORS 165.690, 165.692 and 165.694

As used in ORS 165.690, 165.692 and 165.694: (1) “Claim for health care payment” means any request or demand for a health care payment, whether made in the form of a bill, claim form, cost report, invoice, electronic transmission or any other document. “Claim for health care payment” does not include any statement by a person on an application for coverage under a contract or certificate of health care coverage issued by an insurer, health care service contractor, health maintenance organization or other legal entity that is self-insured and provides health care benefits to its employees. (2) “Health care payment” means money paid in compensation for the delivery of specified health care services, whether under a contract, certificate or policy of insurance, by a health care payor. (3) “Health care payor” means: (a) Any insurance company authorized to provide health insurance in this state; (b) A health maintenance organization; (c) A health care service contractor; (d) Any legal entity that is self-insured and provides benefits for health care services to its employees; (e) Any legal entity responsible for handling claims for health care services under a state or federal medical assistance program; (f) The State of Oregon or any local government within this state that makes payments for health care services; (g) Any insurer authorized under ORS chapter 731 to transact workers’ compensation or casualty insurance in this state; or (h) Any employer authorized under ORS chapter 656 to self-insure its workers’ compensation risk. (4) “Health care services” means any medical or remedial care or service, including supplies delivered in connection with the care or service, that is recognized under state law. (5) “Person” means an individual, corporation, partnership or association that provides health care services or any other form of legal or business entity that provides health care services.