Provider Matters - September 29, 2017

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Updates about claim processing, policy and resources for Oregon Medicaid providers

September 29, 2017

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In this issue ...

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Important reminders

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October 1, 2017, Prioritized List of Health Services

The Health Evidence Review Commission (HERC) has published the pending Prioritized List of Health Services, effective October 1, 2017. Changes include:

  • Placed 281 new ICD-10-CM codes 
  • Removed 34 CPT codes from inappropriate lines, resulting in 106 removed pairings
  • Removed 91 ICD-10-CM codes that become obsolete October 1
  • Added 55 ICD-10-CM codes, five HCPCS codes and 211 CPT codes to existing lines, resulting in 592 new pairings
  • Added nine new practice guidelines and revised 22 guidelines
  • Revised seven coding specifications
  • Updated language for the statement of intent on palliative care

For a full description of the changes, please read HERC’s September 1 letter.

To get Prioritized List updates as they happen, sign up for HERC email updates.

Provider CCO Change Request process ends September 30, 2017

On September 30, 2017, OHA will end the “Provider CCO Change Request” process. This process was a temporary solution to changing CCO enrollments when:

  • Members wanted to keep their current primary care provider, and
  • Their PCP was part of a different CCO network.

If members still need to change CCOs so they can keep their PCP, they can:

  • Ask online using their self-service ONE account. To do this, members can login, click “Report a change in circumstances,” and mark that they want to change their CCO. Members can learn how to sign up for and use a ONE account at
  • Call OHP Client Services at 800-273-0557. Their hours are Monday through Friday, 8 a.m. to 5 p.m.

If members want to have fee-for-service medical so they can keep their PCP:

  • American Indian or Alaska Native members can fill out the OHP 720 and send it to OHA.
  • Medicare members should contact their local Aging and People with Disabilities office.
  • All other members should call OHP Client Services at 800-273-0557.

Training and technical assistance

October 5 webinar: Accessible Design for Hospitals and Medical Care Facilities

The U.S. Access Board is hosting a free webinar about accessibility requirements for medical care facilities, including hospitals and long-term care facilities. Webinar attendees can earn continuing education credits.

Presented with the American Institute of Architects, the webinar will cover:

  • Provisions for medical care facilities in the ADA and ABA Accessibility Standards
  • Solutions to various design challenges
  • Design strategies that both comply with the standard and meet the needs of older adults and their caregivers.

About the U.S. Access Board
A leading source of information on accessible design, the Access Board:

  • Provides technical assistance and training on accessibility requirements
  • Enforces accessibility standards that cover federally funded facilities
  • Hosts a free monthly webinar about accessibility standards.
    Archives of past webinars are available online.

Civil rights and privacy resources for people living with HIV/AIDS

The U.S. Department of Health and Human Services Office for Civil Rights (OCR) enforces civil rights laws that prohibit discrimination on the basis of race, color, national origin, disability, age, sex, religion or exercise of conscience.

OCR has announced two resources related to HIV/AIDS:

To learn more about OCR’s work on HIV/AIDS issues, visit the OCR website’s page on these issues.

To learn more about non-discrimination and health information privacy laws, and to find information on filing a complaint, visit the OCR home page at

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Institutional and professional claims will require attending and referring physician IDs starting November 1, 2017

Starting November 1, OHA requires the following on fee-for-service claims:

  • The attending physician’s NPI and Oregon Medicaid ID on institutional claims
  • The referring physician’s NPI and Oregon Medicaid ID on professional claims (when applicable) 

To prepare for this change, please be sure that your attending and referring physicians are enrolled with Oregon Medicaid.

    • To do this, go to the Oregon Medicaid NPI Verification screen, enter the physician’s NPI and click “Search.”
    • The “NPI Search Results” will clearly tell you whether the physician’s NPI is actively enrolled with Oregon Medicaid. 

    To enroll attending and referring physicians with Oregon Medicaid, please complete the OHP 3113 form and fax to OHP Provider Enrollment at 503-378-3074 (Salem).

    OHA only accepts NPI and Oregon Medicaid provider IDs on claims

    OHA only accepts the provider’s NPI and Oregon Medicaid ID in the attending, rendering, referring and billing provider fields of claims.

    Please do not enter other values, such as taxonomy codes or UPINs, in provider ID fields. Claims that contain any values other than NPI and Oregon Medicaid ID may be denied.

    To learn more about how to submit claims to OHA, visit the OHP Billing page.

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    Rules and program changes

    Recent temporary rules

    Rule revisions to incorporate 42 CFR 440.70 – Add requirements for a face-to-face encounter for certain durable medical equipment (DME) and supplies; amend definition of DME and supplies; remove limitations to only in-home use; clarify that there are no absolute exclusions of DME.

    410-131-0120 – Remove hippotherapy from the exclusion list to align with State Plan and Prioritized List of Health Services.

    September 1 Preferred Drug List (PDL) and August 21 Prior Authorization Criteria – Updates following May 25, 2017, DUR/P&T action. For current PDL and criteria, go to

    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.

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    Need help?

    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 at 888-690-9888.
    • 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.