Billing or medical fee disputes
Note: In an effort to improve the timeliness of resolving medical disputes, you can fax your disputes to the Medical Resolution Team. This will help decrease review time by 48 hours or more. When faxing your submission, please use a cover page clearly identifying your facility. Thank you.
Parties must request administrative review by the director within 90 days of the explanation of benefits (EOB) mailing date, or for workers, within 90 days of the knowledge of the dispute.
For billing disputes (such as the insurer's reduction of a medical bill or failure to pay within 45 days), use Form 2842 and include supporting documentation such as a copy of the original bill and chart notes. Use attachment 2842a to list specific CPT codes and dates of services in dispute.
Medical treatment disputes
These may be initiated by any party using Form 2842 within 90 days of when the aggrieved party knew or should have known there was a dispute. The insurer can request administrative review by the director to contend treatment is excessive, inappropriate or unnecessary, or in violation of a medical services rule. The provider can request administrative review by the director if the insurer does not approve palliative care, curative care, elective surgery, etc.
Disputes over MCO claims
For claims enrolled in a managed care organization (MCO), medical service or treatment disputes must go to the MCO for dispute resolution before the worker can request administrative review by the director. Requests for review through the MCO dispute resolution process must be made to the MCO within 30 days of the mailing date of the initial MCO decision. Requests for review of the final decision of the MCO must be made to the Workers' Compensation Division's Medical Resolution Team within 60 days of the mailing date of the MCO decision.
Workers' Compensation Division
Medical Resolution Team
350 Winter St. NE
P.O. Box 14480
Salem, OR 97309-0405
Fax: 503-947-7629
Mediation and alternative dispute resolution processes are also available to resolve disputes between parties.