Oregon Law
Law as of Jan 1, 2026
Chapter contents
735.005Definitions for ORS 735.005 to 735.145 735.015Purpose 735.025Construction 735.035Application 735.045Oregon FAIR Plan Association; insurers required to be members; plan of operation 735.055Association board of directors; appointment; compensation, expenses of members; quorum 735.065Required association functions; assessments 735.075Discretionary association functions 735.085Plan of operation; submission to director; approval of plan; compliance with plan; rules 735.095Contents of plan of operation 735.105Regulation of association as insurer; financial report to director 735.115Exemption of association from fees and taxes 735.125[1971 c.321 §14; repealed by 1979 c.818 §5] 735.135[1971 c.321 §15; repealed by 1979 c.818 §5] 735.145Immunity from legal action in carrying out duties 735.150Definitions for ORS 735.150 to 735.190 735.152Application of laws 735.154Rules 735.156Confidentiality of documents and materials; public disclosure 735.158Certificate of authority; restriction on types of insurance; requirements for certification; requirements for corporations; fees; expiration and renewal of certificate 735.160Business name 735.162Capital and surplus requirements; form permitted; security for branch captive insurers; dividends and distributions 735.164Incorporation of pure captive insurer and association captive insurer; application; fee; approval; alien captive insurer; application of corporation laws 735.166Investment requirements for association captive insurer 735.168Allowable risks for captive insurer; risk distribution pool; annual actuarial opinion; rules 735.170Rating organization 735.172Reporting; contents; filing date; waiver of annual statement for alien captive insurer; rules 735.174Examination; frequency; scope; payment of expenses 735.176Compliance with sound actuarial principles 735.178Suspension or revocation of certificate of authority 735.180Branch captive insurer as pure captive insurer; rules 735.182Examination of branch captive insurer and alien captive insurer; payment of charges and expenses 735.184Requirements for foreign captive insurer to provide insurance in this state 735.186Management of assets of captive reinsurer 735.188Application of captive reinsurer for certificate of authority 735.190Incorporation of captive reinsurer 735.200Legislative findings; purpose 735.205Definitions for ORS 735.200 to 735.260 735.210Formation of market assistance plans; rules 735.215Findings prior to formation of joint underwriting association; hearing 735.220Formation of joint underwriting association; funds 735.225Membership in joint underwriting association 735.230Rates; approval 735.235Board of directors 735.240Annual statement 735.245Conditions for policyholder surcharge 735.250Exemption from liability 735.255State not liable to pay debts of association 735.260Rules 735.265Liquor liability insurance risk and rate classifications; rules 735.300Purpose of ORS 735.300 to 735.365 735.305Definitions for ORS 735.300 to 735.365 735.310Qualifications for risk retention group; plan of operation; application; notification to National Association of Insurance Commissioners 735.315Foreign risk retention groups; conditions of doing business in Oregon; prohibited acts 735.320Relationship to insurance guaranty fund and joint underwriting association 735.325Exemption of purchasing groups from certain laws 735.330Purchasing groups; notice of intent to do business; registration; exceptions 735.335Purchase of insurance by purchasing group 735.340Insurance Code enforcement authority subject to federal law 735.345Violation of 735.300 to 735.365; penalties 735.350Agent or broker; license 735.355Court orders enforceable in Oregon 735.360Rules 735.365Short title 735.400Purposes of ORS 735.400 to 735.495 735.405Definitions for ORS 735.400 to 735.495 735.406Cost of living adjustment to net worth, revenues and expenses of exempt commercial purchasers 735.410Conditions for procuring insurance through nonadmitted insurer; rules 735.415Qualifications for placement of coverage with nonadmitted insurer 735.417Insured required to report and pay taxes on independently procured insurance covering Oregon home state risks 735.418Director authorized to enter into interstate compact for premium tax allocation 735.420Declaration of ineligibility of surplus lines insurer 735.425Filing by licensee after placement of surplus lines insurance 735.430Surplus Line Association of Oregon; fees 735.435Evidence of insurance; contents; change; penalty; notice regarding Insurance Guaranty Association; rules 735.440Validity of contracts 735.445Effect of payment of premium to surplus lines licensee 735.450Requirements for license as surplus lines insurance licensee 735.455Authority of licensee; rules 735.460Records of licensee; examination 735.465Monthly reports; rules 735.470Premium tax; collection; payment; refund; rules 735.475Suit to recover unpaid tax 735.480Suspension or revocation of license; refusal to renew; grounds 735.485Actions against surplus lines insurer 735.490Jurisdiction in action against insurer; service of summons and complaint; response 735.492Application of certain Insurance Code provisions to surplus lines insurers 735.495Short title; severability 735.500Requirements for certification as retainer medical practice; disclosures; rules 735.510Notice to department of specified changes to practice 735.515Charges for services not covered by contract 735.520Oregon Essential Workforce Health Care Program; supplemental payments to eligible employers; requirements for participation; rules 735.530Definitions for ORS 735.530 to 735.552 735.532License to transact business as pharmacy benefit manager; fees; rules 735.533Denial, suspension or revocation of license to transact business as pharmacy benefit manager; basis; complaint; rules 735.534Claim reimbursement; maximum allowable costs; documentation; complaints; rules 735.536Requirements for pharmacy benefit manager’s reimbursement for cost of drugs; rules 735.537Reports to department regarding payments received from manufacturers and disposition of payments from manufacturers 735.538Reports to department regarding manuals and contracts with pharmacy services administrative organizations 735.540Definitions for ORS 735.540 to 735.552 735.542Pharmacy claims audits; requirements 735.544Pharmacy claims audits; standards for review of claims 735.546Pharmacy claims audits; auditors 735.548Pharmacy claims audits; validation of claims 735.550Pharmacy claims audits; reports of findings; opportunity to resubmit claim and to contest finding 735.552Pharmacy claims audits; exception for fraud 735.600[1987 c.838 §2; repealed by 2013 c.698 §42, 2013 c.640 §20 and 2017 c.477 §4] 735.601[2016 c.94 §1; 2021 c.569 §9; renumbered 413.610 in 2021] 735.604[2016 c.94 §2; renumbered 413.611 in 2021] 735.605[1987 c.838 §3; 1989 c.838 §6; 2003 c.33 §4; 2005 c.634 §4; 2009 c.695 §1; repealed by 2013 c.698 §42, 2013 c.640 §20 and 2017 c.477 §4] 735.608[2016 c.94 §3; 2021 c.569 §10; renumbered 413.612 in 2021] 735.610[1987 c.838 §4; 1989 c.838 §7; 1993 c.744 §190; 1995 c.79 §361; 2001 c.356 §1; 2003 c.364 §95; 2009 c.595 §1118; 2009 c.828 §71; 2011 c.70 §19; 2013 c.698 §6; repealed by 2013 c.698 §42, 2013 c.640 §20 and 2017 c.477 §4] 735.611[2016 c.94 §4; repealed by 2021 c.569 §41] 735.612[1989 c.838 §§2,3; 1993 c.744 §191; 2009 c.595 §1119; 2013 c.698 §14; 2014 c.80 §1; 2017 c.477 §5; repealed by 2017 c.477 §6] 735.614[1989 c.838 §4; 1991 c.333 §1; 1995 c.603 §28; 2005 c.304 §1; 2005 c.635 §1; 2009 c.595 §1120; 2009 c.695 §3; 2011 c.131 §1; repealed by 2013 c.698 §42 and 2013 c.640 §20] 735.615[1987 c.838 §5; 1989 c.838 §11; 1993 c.130 §1; 1993 c.212 §1; 1999 c.754 §1; 2005 c.305 §§1,3; 2005 c.634 §1; 2005 c.635 §§2,3; 2009 c.695 §4; 2011 c.70 §20; 2011 c.602 §57; repealed by 2013 c.698 §42, 2013 c.640 §20 and 2017 c.477 §4] 735.616[Formerly 743.763; 1999 c.987 §1; 2001 c.356 §2; 2009 c.695 §5; 2013 c.698 §15; repealed by 2013 c.698 §42, 2013 c.640 §20 and 2017 c.477 §4] 735.617[2016 c.94 §5; 2021 c.569 §11; renumbered 413.613 in 2021] 735.620[1987 c.838 §6; 1989 c.838 §12; 2005 c.635 §4; repealed by 2013 c.698 §42, 2013 c.640 §20 and 2017 c.477 §4] 735.625[1987 c.838 §8; 1989 c.838 §13; 1993 c.130 §2; 1995 c.603 §27; 1999 c.987 §2; 2001 c.356 §3; 2003 c.684 §5; 2005 c.634 §2; 2005 c.635 §5a; 2009 c.595 §1120a; 2013 c.688 §93; 2013 c.698 §16; repealed by 2013 c.698 §42, 2013 c.640 §20 and 2017 c.477 §4] 735.630[1987 c.838 §9; 1989 c.838 §14; 2009 c.595 §1121; 2013 c.698 §7; repealed by 2013 c.698 §42, 2013 c.640 §20 and 2017 c.477 §4] 735.631Definitions for ORS 735.631 to 735.643 735.632License requirement for conducting business as discount medical plan organization 735.633Requirement for contract with provider; contents of contract; retention of record 735.634License application; investigation; issuance; grounds for denial 735.635[1987 c.838 §10; 1989 c.838 §15; 2013 c.698 §8; repealed by 2013 c.698 §42, 2013 c.640 §20 and 2017 c.477 §4] 735.636Duties of licensee 735.637License term; renewal; rules 735.638Duties of discount medical plan organization 735.639Prohibited activities 735.640[1987 c.838 §12; 1989 c.838 §16; repealed by 2013 c.698 §42 and 2013 c.640 §20] 735.641Investigative powers of director; expenses 735.642License suspension, revocation or failure to renew; grounds; effect 735.643Injunction; damages; venue; time for commencing action 735.645[1987 c.838 §13; 1989 c.838 §17; 1993 c.130 §3; 2005 c.22 §489; 2005 c.634 §3; 2013 c.698 §17; repealed by 2013 c.698 §42, 2013 c.640 §20 and 2017 c.477 §4] 735.650[1987 c.838 §14; 1989 c.701 §72; 1989 c.838 §18; 1999 c.987 §3; 2001 c.356 §4; 2003 c.87 §20; 2013 c.698 §18; repealed by 2013 c.698 §42, 2013 c.640 §20 and 2017 c.477 §4] 735.700[Formerly 653.705; 2003 c.742 §§1,6; 2005 c.238 §§1,2; 2005 c.262 §§1,2; 2005 c.727 §§1,2; 2005 c.744 §§14,15; 2011 c.70 §23; repealed by 2013 c.681 §65 and 2013 c.640 §21] 735.701[2005 c.744 §2; 2009 c.595 §1123; 2009 c.867 §49; 2013 c.365 §5; repealed by 2013 c.681 §65 and 2013 c.640 §21] 735.702[Formerly 653.715; 2003 c.364 §96; 2003 c.742 §§2,7; 2005 c.744 §§16,17; 2011 c.70 §24; repealed by 2013 c.681 §65 and 2013 c.640 §21] 735.703[2005 c.744 §3; repealed by 2013 c.681 §65 and 2013 c.640 §21] 735.704[Formerly 653.725; repealed by 2005 c.744 §41] 735.705[2005 c.744 §4; repealed by 2013 c.681 §65 and 2013 c.640 §21] 735.706[2001 c.716 §16; 2005 c.744 §18; 2009 c.595 §1124; repealed by 2009 c.595 §1204] 735.707[2005 c.744 §5; repealed by 2013 c.681 §65 and 2013 c.640 §21] 735.708[Formerly 653.735; repealed by 2005 c.744 §41] 735.709[2005 c.744 §10; repealed by 2013 c.681 §65 and 2013 c.640 §21] 735.710[Formerly 653.745; 2003 c.742 §§3,8; 2005 c.238 §§3,4; 2005 c.262 §§3,4; 2005 c.727 §§3,4; 2005 c.744 §§19,20; 2011 c.70 §25; 2013 c.365 §6; repealed by 2013 c.681 §65 and 2013 c.640 §21] 735.711[2007 c.619 §3; repealed by 2011 c.720 §228] 735.712[Formerly 653.747; 2005 c.744 §21; repealed by 2013 c.681 §65 and 2013 c.640 §21] 735.714[2003 c.742 §12; 2005 c.744 §22; repealed by 2011 c.70 §26] 735.720[Formerly 653.800; 2003 c.684 §8; 2005 c.727 §§5,5a; 2005 c.744 §§23d,23e,23g; 2007 c.70 §317; renumbered 414.841 in 2009] 735.721[2009 c.470 §1; 2013 c.69 §1; 2015 c.318 §43; repealed by 2017 c.101 §50 and 2017 c.384 §13] 735.722[Formerly 653.805; 2003 c.128 §1; 2003 c.683 §4; 2003 c.784 §12; 2005 c.238 §6; 2005 c.262 §6; 2005 c.727 §6; 2005 c.744 §24a; 2009 c.595 §1125; renumbered 414.842 in 2009] 735.723[2009 c.470 §2; 2013 c.69 §2; 2015 c.318 §44; repealed by 2017 c.101 §50 and 2017 c.384 §13] 735.724[Formerly 653.810; 2003 c.128 §2; 2003 c.683 §1; 2005 c.238 §7; 2005 c.262 §7; 2005 c.727 §7; 2005 c.744 §25; renumbered 414.844 in 2009] 735.725[2009 c.470 §3; repealed by 2017 c.101 §50 and 2017 c.384 §13] 735.726[Formerly 653.815; 2005 c.744 §26; renumbered 414.846 in 2009] 735.727[2009 c.470 §4; 2015 c.318 §45; repealed by 2017 c.101 §50 and 2017 c.384 §13] 735.728[Formerly 653.820; 2005 c.744 §27; renumbered 414.848 in 2009] 735.730[Formerly 653.825; 2005 c.744 §28; renumbered 414.851 in 2009] 735.731[2003 c.683 §3; 2003 c.735 §12; 2005 c.744 §29; renumbered 414.852 in 2009] 735.732[Formerly 653.830; 2005 c.744 §30; renumbered 414.854 in 2009] 735.733[2003 c.684 §11; 2005 c.744 §31; renumbered 414.856 in 2009] 735.734[Formerly 653.835; 2005 c.744 §32; 2009 c.595 §1126; renumbered 414.858 in 2009] 735.736[Formerly 653.840; 2005 c.744 §33; renumbered 414.861 in 2009] 735.738[Formerly 653.845; 2005 c.238 §8; 2005 c.727 §8; renumbered 414.862 in 2009] 735.740[Formerly 653.850; 2003 c.684 §9; 2005 c.744 §34; 2007 c.71 §238; renumbered 414.864 in 2009] 735.750[2003 c.684 §1; 2005 c.744 §35; renumbered 414.866 in 2009] 735.752[2003 c.684 §2; renumbered 414.868 in 2009] 735.754[2003 c.684 §3; 2005 c.744 §36; 2009 c.595 §1127; renumbered 414.870 in 2009] 735.756[2003 c.684 §4; 2009 c.595 §1128; renumbered 414.872 in 2009] 735.990[1987 c.774 §135; repealed by 1991 c.810 §29]

Chapter 735 — Alternative Insurance

ORS 735.544 Pharmacy claims audits; standards for review of claims

An entity’s finding that a claim was incorrectly presented or paid must be based on identified transactions and not based on probability sampling, extrapolation or other means that project an error using the number of patients served who have a similar diagnosis or the number of similar prescriptions or refills for similar drugs.

Note: See note under 735.530.

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Version history

Prior statutory text is not available in the ingested published editions. Consult an earlier official ORS edition or the cited Oregon Laws chapter.