 In this issue ...
Verify OHP eligibility and CCO enrollment on the date of service
All Medicaid providers must check eligibility and enrollment
of a patient on the date of service.
- For CCO members, use the CCO’s eligibility verification service.
- For fee-for-service members, use the Provider Web Portal at https://www.or-medicaid.gov or Automated Voice Response (AVR) at 866-692-3864.
Once you have verified a patient's OHP eligibility, please document
that proof of eligibility in the patient’s file. For example, you can make a
screen shot of Provider Web Portal eligibility results. If you use AVR, you can
choose to get a printout of the eligibility results faxed to your location
(learn how by reading the AVR
user guide).
To learn more, visit our Eligibility Verification
page.
Tips on navigating OHA's new and improved website
This week, the Oregon Health Authority (OHA) unveiled the new OHA website, redesigned to give you and other visitors the best
experience possible.
To make sure you can find what you need, please read our fact
sheet about the website changes. It includes a list of the
most-visited pages and where to find them.
Provider collaborative webinar – Wednesday, June 28, 1-2 p.m.
This month’s
topics:
-
OHP applications that are flagged in Oregon Eligibility (ONE) and reviewed for a possible referral to a local DHS Aging and People with Disabilities (APD) branch office
-
The APD referral process and next steps for clients seeking APD medical programs
Link to register: https://register.gotowebinar.com/register/5134475592999291394
Paper claim processing time is now 14 to 21 days
For those who submit paper claims, please note that OHA has made operational changes that will extend the processing time for paper claims to 14-21 days. For faster processing, you can submit claims on
the Provider Web Portal at https://www.or-medicaid.gov.
- All you need is your Oregon Medicaid Provider ID and internet access with a compatible browser (Microsoft Internet Explorer 6 through 10 or Mozilla Firefox 2.0).
- You get claim status in real time, and complete claim processing within the week.
To learn more about the Provider Web Portal, visit our Provider Web
Portal page.
Payment Error Rate Measurement (PERM) for FFY 2017
For the federal fiscal year (FFY) 2017 PERM cycle, the CMS
PERM review contractor, Chickasaw Nation Industries (CNI), will review a random
selection of Oregon Medicaid and CHIP claims paid between October 1, 2016, and
September 30, 2017, for proper payment. This review will happen between June
2017 and November 2018.
If a claim for a service you rendered is selected for
review:
- CNI will contact you by phone and send a letter.
- The letter will tell you what documentation to send, where to send it, and when.
- You will need to provide CNI a complete copy of the medical records supporting the specific claim.
CNI will use this information to determine if the service
was provided, medically necessary and properly coded. The review also will determine
if the service was paid in compliance with state policy. For more information about PERM, see the CMS PERM website or Provider
Education FAQs. If you have questions, email PERMproviders@cms.hhs.gov or your state
PERM representative, Barbara Key at barbara.key@state.or.us.
Recent temporary rules
410-120-1340
(General Rules): Annual RVU update for physician services, clinical lab and
ambulatory surgical centers
410-121-0040
(Pharmaceutical Services): Amending fee-for-service prior authorization criteria
410-130-0015
(Doula Services): Amended to clarify that a minimum of four doula care visits
plus services on the day of delivery are required for the doula services global
rate
Sign up to get rule updates via text or email
You can also sign up to get text or email updates about:
To learn more, read about how
to sign up for rulemaking notices.
Find more phone numbers, email addresses and other resources in OHA's Provider Contacts List.
-
Claim-specific questions and issues – Contact Provider Services at 800-336-6016.
-
EDI and the 835 ERA – Contact EDI Support Services.
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Direct deposit information and provider enrollment updates - Contact Provider Enrollment at 800-422-5047.
-
Pharmacy and prescriber questions (for technical help and fee-for-service prescription PAs) – Contact the Oregon Pharmacy Call Center at 888-202-2126. You can also fax PA requests to 888-346-0178.
- Prior authorization status – Call the PA Line at 800-642-8635 or 503-945-6821 (outside Oregon).
-
Web portal help and resets – Contact Provider Services at 800-336-6016.
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