 In this issue ...
HERC to consider chronic pain diagnoses, services for the Oregon Health Plan
The Health Evidence Review Commission (HERC) will consider changes to Oregon
Health Plan coverage of chronic pain treatments and services, to be effective on or
after January 1, 2020. Proposed changes include:
- Adding coverage for five diagnoses related to chronic and complex pain that
OHP does not currently cover;
- Covering non-pharmacological pain management services;
- Limiting access to prescription opioids up to 90 days; and
- New guidelines to taper patients already on long-term opioid therapy.
The Chronic Pain Task Force is proposing these changes only as a starting point for
discussion. HERC expects to vote on this proposal no sooner than its October
meeting. HERC will take public testimony at the August 9, 2018 Value-based Benefits
Subcommittee meeting and accept written testimony for this meeting until noon
Tuesday, August 7.
Other opportunities for public comment will be available as the process continues. Providers, partners and patients are all encouraged to provide input on this proposal.
To learn more
Visit the HERC website. For meeting accommodations, email
herc.info@dhsoha.state.or.us at least 48 hours before the meeting date.
As of July 1, 2018, Prescription Drug Monitoring Program enrollment is
mandatory for all licensed health care professionals with a DEA number
House Bill 4143 (2018) requires Oregon practitioners who prescribe drugs in DEA
Schedules II through IV or naloxone to enroll in the Oregon Health Authority's Prescription Drug Monitoring Program (PDMP).
- Established in 2009, the PDMP monitors and reports prescriptions for Schedule
II through IV controlled substances and naloxone.
- If you have an active Oregon license and an Oregon DEA registration, please
register for the PDMP at https://oregon.pmpaware.net/login.
To learn more
You can view short videos on how to register and use the PDMP on the Oregon Pain
Guidance website, and learn more about the program at http://www.orpdmp.com/.
If you have questions, concerns, or issues with registration or use of the PDMP,
please email pdmp.health@dhsoha.state.or.us.
Oregon Pharmacy and Therapeutics Committee accepting applications for 2019-2020 appointments
The Oregon Health Authority is accepting applications for the 2019-2020 Oregon Pharmacy and Therapeutics (P&T) Committee. To apply:
To learn more
To learn more about the P&T Committee, visit the P&T website.
If you have any questions about the application process, please contact Roger Citron
at 503-947-5220.
Improvements to the OHP provider enrollment processes
OHA has made the following changes to improve the provider enrollment process:
Website changes
The OHP Provider Enrollment page is now organized by type of enrollment update:
Initial enrollment, change reporting and licensure renewal.
Process changes
Starting August 17, 2018, OHA will only accept ownership changes and other
changes sent to 503-378-3074 when they are sent under an EDMS coversheet, and completed on the 2018 forms.
To learn more
Visit the updated OHP Provider Enrollment page.
If you still have questions, call Provider Enrollment at 800-336-6016 (Option 6) or
email provider.enrollment@dhsoha.state.or.us.
How to complete the Emergency Flag field on CMS-1500 and OHP 505 paper claims
When billing for professional services provided in an emergency situation, flag as
follows:
-
CMS-1500 (Box 24C): Enter a “Y” in this box.
-
OHP 505 (Field 14): Check this box.
If no emergency services were provided, leave this field blank.
To learn more
For more information about billing OHA, visit the OHP Billing Tips page.
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).
To learn more
For more information about this requirement, read OHA’s reminder for prescribing
practitioners and licensing boards.
Recent rule revisions
-
410-141-3010 - Revisions to CCO Recertification Requirements Necessary to
Align with 2019 Contract Extensions
-
410-141-0520 - Updates the covered and non-covered services according to
the Prioritized List
-
410-180-0300, 0305, 0310, 0312, 0320, 0325, 0340, 0350, 0355, 0370, 0380 -
Add Family Support Specialist and Youth Support Specialist to Definitions,
Certification, and Recertification Requirements
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).
-
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.
|
