In this issue ...
January 1, 2018 Prioritized List of Health Services
Please read the Interim Modifications letter to learn about changes to the Prioritized List of Health Services effective January 1, 2018. Changes include:
- Placement of 58 new CPT codes and 22 new HCPCS codes
- Removal of three ICD-10 CM codes, 16 CPT codes and one HCPCS code from inappropriate lines, resulting in removal of 74 condition/treatment pairs
- Placement of new ICD-10-CM codes, 75 CPT codes and one HCPCS code, resulting in 411 new and appropriate condition/treatment pairs
- New lines (500 and 660) to list codes minimal or no clinical benefit or cost effectiveness (as reported in the November issue of Provider Matters).
- Six new practice guidelines, 11 revised guidelines and one deleted guideline
- Four new coding specifications
Please call or email Provider Services for training help
The Medicaid.Provider-Training@dhsoha.state.or.us mailbox is closing on January 12, 2018. If you need training as an OHP provider, please review these resources:
If you still need help, please email Provider Services at dmap.providerservices@dhsoha.state.or.us.
Requirements for paper claim forms
Providers can now submit all claim types electronically, except for ones that require attached documentation. These require billing on paper claim forms.
When billing using paper claim forms, please remember:
- OHA only accepts the 2012 CMS-1500 form, the ADA 2012 form, the UB-04 form, and the OHP 505 form.
- The CMS-1500 and UB-04 paper claim forms must be commercially available, “red ink” versions (no faxes, printouts or other black and white versions).
- The ADA 2012 and OHP 505 forms are not available as “red ink” forms. Black and white copies are acceptable.
- OHA only accepts paper claims by mail. The main address for all claim types is PO Box 14955, Salem OR 97309. Claims sent to branches, ONE or other locations may be delayed or not processed. For other addresses, please see our Provider Contacts List.
On professional and institutional claims, text must be left-aligned in these fields:
- Professional: Client name, client ID, date of service (line 1 only)
- Institutional: Type of Bill, Statement From and Through Dates, Patient Name
To learn more, read the “Paper billing instructions” section of the billing handbooks available on the OHP Billing page.
Upcoming rule revisions
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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