 In this issue ...
FamilyCare member transition
The Oregon Health Authority (OHA) has transitioned about 100,000 FamilyCare members to Health Share of Oregon, Willamette Valley Community Health and Yamhill Community Care.
FamilyCare services ended January 31, 2018. If you or your patients have questions about this change, please refer to the FamilyCare transition page or these customer service numbers.
As always, please be sure to verify your patient’s OHP eligibility and CCO enrollment before providing service.
Fee-for-service (FFS) dental rate increases effective February 1, 2018
As you may know, OHA plans to update the FFS payment rates for the Dental Services program as follows, pending approval by the Centers for Medicare & Medicaid Services:
- Apply a 10 percent rate increase to specific diagnostic and preventive codes, and
- Apply a 30 percent rate increase to specific oral surgery codes.
The rate increase will apply to care and services provided on or after February 1, 2018.
To view the list of codes affected by this change, please review OHA’s January 12 letter for FFS dental providers.
Please include “From” and “To” dates on all paper claims
When submitting paper claims to the Oregon Health Authority (OHA), please include the service “From” and “To” dates on all claims, where applicable.
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CMS-1500: Box 24A (Dates of Service), for all detail lines
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OHP 505: Box 22A (Dates of Service), for all detail lines
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UB-04: Field Locator (FL) 6 (Statement Covers Period)
If you do not enter this information, the claim will deny. OHA will not enter this information for you. To learn more, visit the OHP Billing Tips page.
Billing provider ID is required on all claims
Please remember to complete the “Billing Provider” field of all claims. This field must list the National Provider Identifier (NPI) and/or Oregon Medicaid ID of the provider that OHA will send payment to.
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CMS-1500: Box 33. Enter NPI in part “a,” Oregon Medicaid ID in part “b”
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OHP 505: Box 31. Enter NP in part “a,” Oregon Medicaid ID in part “b”
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UB-04: FL 56 (NPI) and FL 57 (Oregon Medicaid ID)
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ADA 2012: Box 52A
No other information (such as taxonomy codes) should be included. If you include more than what is required in these fields, OHA will return the claim to you to correct and resubmit.
Inpatient claim reprocessing scheduled Feb. 2, 2018, for DRG hospitals
To complete implementation of Version 35 of the Diagnosis-Related Grouper (DRG), the Oregon Health Authority will reprocess all fee-for-service inpatient claims for DRG hospitals with dates of service between October 1, 2017, and December 17, 2017.
The reprocessing will report on the remittance advice you receive for the Feb. 2 weekend.
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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