 In this issue ...
How to fax prior authorization requests to OHA
If you choose to fax prior authorization (PA) requests to the Oregon Health Authority
(OHA), please be sure to send them only to the following numbers using the current MSC 3971 form:
- 503-378-3435 for immediate (24-hour) and urgent (72-hour) requests
- 503-378-5814 for routine requests
The only times you can fax PA information to other OHA fax numbers are as follows:
- When submitting requests to authorize out-of-state services using the OHP 1074 form; and
- When OHA staff specifically ask you to fax additional information for an existing
request.
Using the Provider Web Portal at https://www.or-medicaid.gov is still the preferred
way to submit requests. You can do all of the following securely and online:
- Submit all information, including required documentation
- Get real-time confirmation that OHA received your request
- Check the status of your request
To learn more
Visit OHA’s Prior Authorization page. You can view the video and slides from OHA’s
webinar about fee-for-service physical health PA requests, and read questions and
answers from the webinar.
Medicaid Electronic Health Records (EHR) Incentive Program: Deadline for Program Year 2017 provider attestations extended to May 31, 2018
Program Year 2017 opened for attestations November 20, 2017. OHA has extended
the deadline for eligible professionals to attest to May 31, 2018.
- Only providers who attested in Program Year 2016 or prior years can submit
attestations for Program Year 2017.
- Attestation requirements, fact sheets and checklists are available on the
program’s Program Year 2017 page.
To learn more
Visit the Medicaid EHR Incentive Program website or contact the Medicaid EHR
Incentive Program team at 503-945-5898 (Salem).
Review your fax machine setup to ensure full processing of faxes to OHA
When you send a fax, connection issues may interrupt the transmission. If this
happens, your fax machine may do one of the following once it reconnects to the
destination fax number:
- Resend the entire fax, or
- Resume sending the rest of the fax.
OHA’s central fax numbers cannot process resumed faxes, because they come in as
a new fax that does not include an EDMS Coversheet.
Please be sure your fax is set up to resend the entire fax if connection issues occur.
This will ensure full processing of each fax you send to OHA’s central numbers for:
- Provider Enrollment at 503-378-3074
- Claim Documentation and Correspondence at 503-378-3086
- Prior Authorization at 503-378-5814 and 503-378-3435
Billing for services to OHP newborns
OHA now automatically enrolls all OHP newborns eligible for coordinated care
organization (CCO) enrollment in CCOA (physical, dental and behavioral health)
enrollment. This change began February 4, 2018.
- If the mother is a CCO member, OHA enrolls the newborn in CCOA effective on
the newborn’s date of birth, even if the mother has a lower level of CCO
enrollment (e.g., CCOG).
- If the mother is a fee-for-service member, OHA enrolls the newborn in CCOA
effective next weekly enrollment cycle (e.g., 1-2 weeks after the date of birth).
When billing for services to OHP newborns, remember to check eligibility and enrollment for the date of service, and bill OHA or the CCO as appropriate.
All prescriber IDs on pharmacy claims must be enrolled with OHA by September 1, 2018
Starting September 1, 2018, the prescribing provider’s National Provider Identifier
(NPI) must be enrolled with OHA in order for the claim to process. This applies to:
- Paper, point of sale, and Provider Web Portal claims billed to OHA, and
- All pharmacy claims reported to OHA by coordinated care organizations.
To prepare for this change, please be sure that your prescribers are enrolled with
OHA.
-
Use OHA’s verification tool to verify enrollment using the provider's NPI.
- For prescribers not enrolled with OHA, complete and fax the OHP 3113 form to OHP Provider Enrollment at 503-378-3074 (Salem).
Where to send paper claims
OHA accepts only the following types of claims at its 500 Summer Street address:
- Hysterectomy and sterilization claims
- Transplant claims
- Out-of-state claims
- Claims over 1 year old
- Requests to reconsider CAWEM claims, pharmacy claims, non-covered service
determinations, and incorrect denials due to administrative error
If you send any other types of claims to 500 Summer Street, OHA will mail them to
the DHS|OHA processing center, which delays processing.
For faster processing:
Recent rule revisions
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410-129-0075 and 410-129-0085 - Adopt Face-to-Face Encounter to Meet
Compliance and Specify Payment Methodology on Accessories for Speech-
Generating Devices (SGD)
-
410-121-0040 - Amending Prior Authorization Approval Criteria Guide
-
410-121-0030 - Amending Preferred Drug List
-
410-172-0745 - Exception Criteria for Facial Gender Confirmation Surgery
-
410-200-0140 - Amends Inmate Eligibility Rules According to SB 233, the
Affordable Care Act, and CMS Guidance
-
410-200-0015, 410-200-0240 - Implementing House Bill 3391 Reproductive
Health and CAWEM Plus Postpartum Eligibility Period
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.
- Claim-specific questions and issues – Contact Provider Services at 800-336-6016 (option 5).
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EDI and the 835 ERA – Contact EDI Support Services or visit the EDI page.
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Provider enrollment updates - Contact Provider Enrollment at 800-336-6016 (option 6).
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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 800-336-6016 (option 3).
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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.
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