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November 2016
In this issue:
Health System Transformation
- Oregonians can now apply online for OHP
- Medicaid Electronic Health Records (EHR) Incentive Program
Other provider updates
- Intermittent phone connectivity issues at OHP call centers
- State offices closed Nov. 24 and 25 for Thanksgiving Day observance
- Coming January 1, 2017: Changes to OHP benefits and copayment requirements
- NDC reporting for outpatient physician-administered drug claims
- New MATx mobile app supports medication-assisted treatment of opioid use disorder
- Reminder: Monthly payment recovery for Oregon Health Plan newborn claims
Oregonians can now apply online for OHP
OHA launched the Oregon Eligibility (ONE) Applicant Portal to the public in late October.
The portal is a new online option for applying for the Oregon Health Plan that is live 24
hours a day, seven days per week. The portal is available in English and Spanish. To
access the portal, applicants should go to OregonHealthCare.gov and answer a few
screening questions.
- For most applicants, the portal will be the fastest way to apply for OHP. For many, the portal will let them know whether they qualify for OHP as soon as they submit their application.
- Members with temporary OHP coverage through Hospital Presumptive Eligibility cannot use the portal to apply for full OHP coverage. Instead, they should submit a paper OHP application (OHA 7210).
Community partners across Oregon are trained to help Oregonians apply through the
ONE Applicant Portal. To find local community partners, visit OregonHealthCare.gov.
- Providers who would like to become a community partner can apply by completing the Application Assistance by Provider Staff (OHP 3128) form.
- Community partners can be hospitals, federally qualified health centers (FQHCs), rural health centers (RHCs), county health departments, substance use disorder treatment and recovery centers, Tribal 638 clinics, Indian Health Service clinics, family planning clinics, and other primary care clinics as approved by OHA.
To learn more about applying for OHP, visit OregonHealthCare.gov.
Questions?
If you have questions about becoming a community partner, email cp.business@state.or.us.
Medicaid Electronic Health Records (EHR) Incentive Program
Program Year 2016 updates for eligible professionals
Eligible professionals can submit their 2016 adopt, implement or upgrade (AIU) and meaningful use (MU) first year attestations until March 31, 2017. Please include the following documents as part of your attestation:
- Copy of meaningful use summary report;
- Security risk assessment (SRA). HealthIT.gov offers an SRA tool to help providers complete this assessment;
- Inventory list;
- Deficiencies noted and the corrective action plan(s), including target dates for implementation; and
- Documentation of who completed the SRA.
This is the last year to begin the program (coming in under AIU or MU payment year one).
- Eligible professionals can receive an incentive payment for adopting, implementing or upgrading certified electronic health record technology (CEHRT) in their first year of participation.
- Eligible professionals must choose to participate in either the Medicare or Medicaid EHR Incentive Program.
For more information
Intermittent phone connectivity issues at OHP call centers
As you may have noticed, our phone lines are experiencing intermittent connectivity
issues. You may be unable to complete a call, or get unexpectedly disconnected, when
dialing the following numbers:
* Email available (allow two to three business days for response)
If this happens to you, please keep trying until you get through. We aren’t hanging up
on you!
Phone technicians also are seeking the cause of the choppy sound quality of calls to and
from State of Oregon phone numbers. If you are on a line that is choppy, one option is
to hang up and try the call again. Thank you for your patience as we continue to work
on this matter.
State offices closed Nov. 24 and 25 for Thanksgiving Day observance
The Health Systems Division, along with most state offices, will be closed this Thursday
and Friday. Go to our Office Closures page to find out which contacts are available on
state office closure dates.
Coming January 1, 2017: Changes to OHP benefits and copayment requirements
To meet federal health plan requirements, OHA is making changes to Oregon Health
Plan (OHP) benefits and copayment requirements. The changes apply to services
covered by OHA and all coordinated care organizations on and after January 1, 2017.
As we get closer to January, we will share more information as it becomes available. To
stay informed:
NDC reporting for outpatient physician-administered drug claims
When billing for outpatient physician-administered drugs using the professional (CMS-
1500) or institutional (UB-04) claim format, please report the National Drug Code of the
drug that was actually dispensed.
The Oregon Health Authority uses this information to collect rebates from drug
manufacturers as part of the Medicaid Drug Rebate Program.
To learn more about NDC reporting requirements, please review the following Oregon
Administrative Rules. Other resources are also on our NDC Reporting page.
New MATx mobile app supports medication-assisted treatment of opioid use disorder
According to the Substance Abuse and Mental Health Services Administration (SAMHSA),
nearly 2.4 million Americans had an opioid use disorder in 2015, and an estimated 80
percent of these individuals did not receive treatment.
MATx empowers health care practitioners to provide effective, evidence-based care for
opioid use disorder. This free mobile app supports practitioners who currently provide
medication-assisted treatment, as well as those who plan to do so in the future.
MATx features include:
- Information on treatment approaches and medications approved by the U.S. Food and Drug Administration for use in the treatment of opioid use disorders, and treatment approaches for practitioners;
- A buprenorphine prescribing guide, which includes information on the Drug Addiction Treatment Act of 2000 waiver process and patient limits;
- Clinical support tools, such as treatment guidelines, ICD-10 coding, continuing education opportunities, and recommendations for working with special populations;
- Access to critical helplines and SAMHSA’s treatment locators.
To learn more and download MATx through Google Play or iTunes, visit the MATx Web
page.
Reminder: Monthly payment recovery for OHP newborn claims
Every month OHA recovers a small number of payments made in the preceding month for services to newborns who are now enrolled in a CCO.
- Once the birth is reported, we enroll children born to CCO members in the mother’s plan.
- Depending on when the birth is reported to us, this process may take three or more weeks to complete.
To avoid future recoveries for newborn services:
What you will see on the paper remittance advice (RA), electronic remittance advice (ERA) or Provider Web Portal (PWP):
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On the paper RA: Adjusted claims will have an Internal Claim Number (ICN) beginning with “52.” The “Detail EOBs” for these ICNs will list Explanation of Benefits (EOB) code EOB 0090 – Service is covered by a managed care plan. Claim must be billed to the appropriate managed care plan.
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On the ERA or PWP: The ERA should list these adjustments as overpayment recoveries. PWP will show the adjustment ICN as a denied claim. In both ERA and PWP, the reason for recovery will be Adjustment Reason Code 24 - Charges are covered under a capitation agreement/managed care plan.
To learn more about recovery of overpayments or appeals, please see Oregon Administrative Rules 410-120-1397(7), 410-120-1560 and 410-120-1580 in the General Rules guidelines. |
