PROVIDER NETWORK RULES for OREGON

Provider Selection
Employee chooses without restriction unless a contract with a managed care organization (MCO) exists. Where an MCO contract exists the injured worker must choose a panel provider unless the MCO approves a non-panel provider, or a “come-along provider” who provides care subject to the MCO terms. A come-along provider is a primary care provider who is not in the MCO, and who continues to treat the worker when the worker becomes enrolled in the MCO.

Managed Care Options
The state certifies MCO’s. Only insurers and self-insureds may contract with an MCO. Additionally, they may also contract with more than one MCO in the state. Employees may choose between MCOs at the time of enrollment.

Provider Lists
Provider lists and directories may be utilized. For an MCO, there is a state-mandated posting, which is distributed by the Managed Care partner. Panels must include a minimum of one attending physician for every 1,000 workers covered.