In this issue ...
Electronic Health Record Incentive Program – Year 2017
On August 1, 2017, the Oregon Health Authority (OHA) opened
Program Year 2017 for Eligible Professionals and Hospitals.
For eligible professionals:
- Only providers submitting applications for their first year of Meaningful Use will be able to attest at this time.
- Those who want to submit an application for later years of Meaningful Use must wait until January 1, 2018.
To learn more, visit the
program’s website.
Please use EDMS Coversheet on all prior authorization and provider
enrollment requests
Please help us process your requests faster by including the
EDMS Coversheet (MSC 3970) as a fax cover sheet for each prior authorization
(PA) and provider enrollment (PE) request you submit to OHA.
- We do not see the faxes sent to our central PA and PE numbers until they are scanned into our system.
- Unfortunately, only requests sent under the EDMS Coversheet get into the system.
- Requests missing this coversheet are destroyed and not returned.
To make sure your faxes are processed and reviewed by OHA,
please read our EDMS Coversheet tips to learn more.
Coming soon – “Upload document” feature for Provider Web Portal prior
authorization requests
Soon, the Provider Web Portal at https://www.or-medicaid.gov will allow
providers to upload required documentation when they submit a prior
authorization request.
- You can upload a scan or text file of the documentation. Supported files are .TXT, .PDF and .TIF/.TIFF.
- This means you can submit all information and documents in one request. No more faxing or calling to provide additional information.
If you prefer, you can still fax in additional information using the EDMS Coversheet (MSC 3970).
To learn more about this feature, visit the Provider Web Portal page.
Changes you may need to make for
new Medicare cards coming in 2018
In April 2018
Medicare members will start getting new Medicare cards with a new Medicare
number (currently called the Medicare Claim Number). You may need to change
your systems to:
- Accept the new Medicare number (Medicare Beneficiary Identifier or MBI).
-
Identify your patients who qualify for Medicare under the Railroad Retirement Board (RRB). You will be able to identify them only by the RRB logo on their card, not their ID number.
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Update your practice management system’s patient numbers to automatically accept the MBI from the remittance advice (835) transaction.
If you use
vendors to bill Medicare, and they haven’t already shared these system changes
with you, please contact them. They can also tell you how they will pass the
new Medicare number to you.
To learn more, visit Medicare’s provider page about the
new card and read the July 13 issue of MLN Connects.
Sign up for the Oregon Health Update to get the latest news about
OHA
Have you heard about the Oregon Health Update? This bulletin
shares information from across OHA, including:
You can view past issues, and sign up to receive future updates, on the OHA website.
HIPAA Right of Access training
The U.S. Department of Health and Human Services (HHS)
Office for Civil Rights (OCR) has launched a new video training about
patients’ right of access under the Health Insurance Portability and
Accountability Act (HIPAA) Privacy Rule.
The training features:
- In-depth review of HIPAA right of access
- How right of access helps patients be more
involved in their own care
- Helpful suggestions on how to integrate access rights
into your practice
Free Continuing Medical Education (CME) and/or Continuing
Education (CE) credit is available for health care professionals who complete
this training.
Link to training: http://www.medscape.org/viewarticle/876110
For this and other training resources, visit OCR’s Training
and Resources page at https://www.hhs.gov/hipaa/for-professionals/training/index.html.
Updates to the OHA 2080 (Trading Partner Agreement)
In our ongoing efforts to make the HIPAA registration
process for Oregon Medicaid electronic data interchange transactions as easy as
possible:
- OHA has updated the Trading Partner Agreement
form (OHA 2080),
effective July 2017.
- OHA will accept both the August 2016 and July
2017 versions of this form.
To learn more about this form, review the form and
self-study guide on our EDI page.
Please add modifier 33 to all claims for preventive services
All preventive services, as indicated on the 1/1/2017
Prioritized List, now qualify for enhanced federal match payments from the
federal Medicaid program.
- This means that federal Medicaid dollars will
pay a bigger share of each of these claims, so that OHA can spend state
Medicaid dollars elsewhere.
- To make this work, we need your help!
When billing for preventive services for OHP members, please
add modifier 33. This includes the following services:
- United States Preventive Services Task Force A
and B recommendations (effective in Oregon one year after their effective
date).
- Recommended vaccines per CDC schedule
- HRSA women’s services
- American Academy Bright Futures services
Adding modifier 33 will allow OHA to report all claims
subject to the enhanced federal match.
Recent temporary rules
Adopting
Division 149 Rules – Payments and participation requirements for
fee-for-service Comprehensive Primary Care Plus Demonstration, effective
8/1/2017
Home
Health Services – Amending to meet Medicaid regulations 42 CFR 440.70,
effective 7/15/2017
410-050-0861
– Hospital Assessment Rate Increase, effective 7/1/2017
410-121-0030
and 410-121-0040
– Preferred Drug List and Prior Authorization Approval Criteria Guide,
effective 7/1/2017
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.
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Claim-specific questions and issues – Contact Provider Services at 800-336-6016.
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EDI and the 835 ERA – Contact EDI Support Services at 888-690-9888.
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Provider enrollment updates - Contact Provider Enrollment at 800-422-5047.
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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).
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Web portal help and resets – Contact Provider Services at 800-336-6016.
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