Provider Matters - April 23, 2018

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

April 23, 2018

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In this issue ...

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Important reminders

Change to accepted fee-for-service prior authorization form effective May 1, 2018

Starting May 1, 2018, the Oregon Health Authority (OHA) will only accept prior authorization requests in two ways:

  • Online: Using the Provider Web Portal at This is the preferred way to submit requests.
  • By fax, on the 2018 version of the MSC 3971 form: Be sure you are using the currently posted version, which corrects the “FROM” field on page 1 so that you can enter your name. Include all three pages, with the EDMS Coversheet as page 1 of your fax.

Sign up for our April 25 webinar to learn more about this change.

Next public meeting about the future of the Oregon Health Plan is April 28

Please register to attend OHA’s public meeting to provide feedback about Oregon Health Plan and its coordinated care organization (CCO) service delivery model. What works, and what needs more work? Let us know!

  • Woodburn – Saturday, April 28, 9 a.m. to noon, Legacy Health Wellspring Conference Center, 1475 Mt. Hood Ave.

OHA will use the feedback you provide to help inform the CCO contracts that will be effective January 1, 2020. To learn more, visit the OHA website.

Complete OHA’s value-based payment provider survey by April 25

To achieve the triple aim of better health, better care and lower costs for all Oregonians, OHA seeks to increase use of value-based payments that will:

  • Incentivize delivery system reform that focuses on value instead of volume, and
  • Reward providers for a combination of positive member outcomes and cost savings.

OHA is working with CCOs to develop a strategy to increase use of these payments in contracts with network providers.  In order to develop a model that works for the provider community, OHA invites all providers to complete a short, 12-question Value-Based Payment survey.

  • The survey requests your feedback on potential approaches.
  • Your responses will help OHA determine the best approach to take.

Please respond today! The survey closes Wednesday, April 25.


If you have questions about the survey, please contact Lisa Krois of OHA Health Policy & Analytics at or 503-551-1346.


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Training and technical assistance

Final session of FFS physical health prior authorization webinar is April 25

Learn how to get your prior authorization requests reviewed faster! This webinar will feature a training video, followed by live Q&A with clinical review professionals from OHA's Health Systems Division.

Who should attend?

Anyone who submits FFS prior authorization requests to OHA for:

  • Medical/surgical services
  • Durable medical equipment and supplies
  • Imaging and laboratory tests
  • Physical or occupational therapy
  • Hearing aids
  • Communication Assistive Devices
  • Speech therapy
  • Out-of-hospital births

Please share this information with others who submit physical health prior authorization requests to OHA.  After April 25, we will work on an on-demand version of this webinar for providers to access at any time.

In the meantime, the slides and questions and answers from all spring webinar sessions,  are on the new OHP prior authorization page.


Coverage of direct-acting antiviral (DAA) medication for hepatitis C treatment

Starting January 1, 2018, OHA has expanded coverage of DAA medication for hepatitis C treatment for all OHP members. Changes to DAA coverage criteria include:

  • Covered for HIV coinfection at any fibrosis stage
  • Covered for METAVIR fibrosis score of F2 or higher
  • Covered for additional extrahepatic manifestations of hepatitis C, such as lichen planus, non-Hodgkin lymphoma, and type 2 diabetes
  • Retreatment with an NS5A inhibitor now covered for patients who have failed therapy for reasons other than non-compliance or lack of follow-up.

The coverage change applies to both FFS and CCO prescriptions of DAA medication for hepatitis C treatment. To learn more, please read the current DAA criteria at, and our recent letter to prescribers.

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Rules and program changes

Recent rule revisions

  • 410-200-0315 – Income Eligibility Guidelines for MAGI Medicaid/CHIP
  • 410-141-3000 and 410-141-3010 and adopt 410-141-3041 – Coordinated Care Organization (CCO) Contract Renewal Notification Requirements
  • 410-130-0015 – Allow Doulas to Be Enrolled for Direct Payment in OHP’s FFS Program
  • 410-001-0000 – Amending Procedural Rules for Sending Notice of Rulemaking Intent to Adopt, Amend, Repeal OARs
  • 410-141-0520 – Updates the Covered and Non-Covered Services According to the Prioritized List

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?

  • Claim-specific questions and issues Contact Provider Services at 800-336-6016 (option 5).
  • EDI and the 835 ERA Contact EDI Support Services or visit the EDI page.
  • Provider enrollment updates - Contact Provider Enrollment at 800-336-6016 (option 6).
  • 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 800-336-6016 (option 3).
  •  Web portal help and resets Contact Provider Services at 800-336-6016 (option 5). 

Find more phone numbers, email addresses and other resources in OHA's Provider Contacts List.