Insurance Company Annual
Patient Protection Reports
Descriptions of reports
Grievance Report - Health insurers in Oregon are required to file an annual report on their ability to promptly resolve consumer complaints. The report identifies a number of grievance
categories; reports how many decisions are upheld or reversed, and at what level of appeal those complaints are resolved.
Utilization Review - Those insurers that require pre-authorization for treatment are required to file an annual summary relating to the insurer's utilization review policies. The report includes
information on how utilization decisions are made; the timeliness of completing reviews and how utilization review criteria is developed and revised. Supplemental reports including work plans, evaluations
and review statistics may also be included with their reporting.
Network Adequacy - Managed Care Organizations are required to file an annual report on the scope and adequacy of their provider network. The report includes the insurer's ongoing monitoring
that all covered services are reasonably accessible to enrollees.
Quality Assessment - Managed Care Organizations are required to file an annual quality assessment report on their ability to identify and achieve relevant quality improvement goals. This
allows insurers to evaluate, maintain and improve the quality of health services provided to enrollees. Insurers may provide supplemental reports related to their quality assessment review including
their goals, work plans and evaluations.