Oregon has some of the fastest payer deadlines in the country on paper: two business days for a prior authorization decision and 30 days to pay a clean claim, with 12% interest after that. Where Oregon practices lose time is the Oregon Health Plan, where a clinician has to be enrolled with the state and then contracted with each coordinated care organization before claims pay.
This guide is for therapy, counseling, psychiatric, and speech therapy practices billing commercial plans and the Oregon Health Plan.
Claim payment and interest
Under ORS 743B.450, an insurer must pay or deny a clean claim within 30 days of receiving it. If it needs more information, it must tell both the patient and the provider in writing within those 30 days what it needs, and then has 30 days after receiving it to pay or deny. A provider contract can't limit these rights.
When an insurer is late, ORS 743B.452 requires simple interest of 12% a year on the amount owed, starting on the 31st day, paid together with the claim. Interest under $2 is not required. Check late payments on your ERA for the interest line; if it is missing, ask for it.
Prior authorization
ORS 743B.423 gives insurers no more than two business days after receiving a non-emergency request to decide. If information is missing, the insurer has two business days to say in writing what it needs, and then must decide by the later of two business days after the answer or 15 days after its request.
An approval for treatment other than drugs is binding until the later of the reasonable duration of the treatment or 60 days after it starts. For therapy, that means an approved course of treatment should hold for at least its first 60 days. Keep the approval letter; it is your proof if a claim in that window is denied for authorization.
These rules cover state-regulated commercial plans. Self-funded employer plans follow federal law instead. For Oregon Health Plan members, the CCO's own authorization rules apply, and since 2026 the federal interoperability rule requires Medicaid managed care plans to decide within 7 calendar days, or 72 hours if expedited.
The Oregon Health Plan and CCOs
Oregon Health Plan (OHP) members are enrolled in coordinated care organizations, each serving a region of the state. Getting paid takes two separate steps:
- Enroll with the Oregon Health Authority. Every billing and rendering provider must be enrolled with OHP. Enrollment confirms the license and NPI and gives you an OHP provider number.
- Contract and credential with each CCO. Being enrolled with the state doesn't put you in a CCO's network. Each CCO has its own application, credentialing committee, and timeline, and in-network rates are often higher than fee-for-service.
Delays between those two steps are common enough that the legislature took them up in 2025 (HB 3229), proposing faster OHA processing, 30-day CCO panel decisions, and retroactive payment to the date of a complete enrollment application. Until a rule like that is in place, plan for credentialing to take months, and start before a new clinician's first day.
Filing limits
For fee-for-service OHP claims, OAR 410-120-1300 sets 12 months from the date of service. A claim that was filed on time and denied can be resubmitted within 18 months, with proof of the original submission. Exceptions exist for state errors, court orders, and retroactive eligibility. Claims for CCO members follow the CCO's contract and separate rules, so check each one.
An Oregon billing checklist
- Enroll each new clinician with OHA first, then apply to every CCO in your area.
- Start CCO credentialing at least four months before the clinician starts seeing OHP members.
- Write down each CCO's filing limit, and bill within 30 days of service regardless.
- Submit prior authorizations with complete clinical information, so the two-day clock starts right away.
- Save every prior authorization approval with its dates and the treatment it covers.
- Flag clean claims unpaid after 30 days and confirm interest is paid on late ones.
- Keep proof of original submission for every denied claim you plan to resubmit.
When to bring in help
Sharp Networks Group handles credentialing and billing for therapy and behavioral health practices in Oregon and other states, inside the EHR you already use. Compare Oregon with other states in our state-by-state guide, or schedule a consultation.
Last reviewed October 2026. Laws, plan policies, and filing limits change. Confirm current rules with each plan, the Oregon Health Authority, and the Division of Financial Regulation.