Provider Matters - August 31, 2018

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Updates about claim processing, policy and resources for Oregon Health Plan providers

August 31, 2018

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In this issue ...

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Important reminders

Proposed changes to Oregon Health Plan (OHP) chronic pain coverage

On September 20, the Chronic Pain Task Force will meet to help set the parameters of an evaluation that will be conducted by the Oregon Health & Science University’s Center for Evidence-based Policy (CEP).

The evaluation will review all available evidence regarding opioid tapering. The Chronic Pain Task Force will take this evaluation into consideration as they prepare a final proposal for OHP chronic pain coverage changes effective January 1, 2020.

To provide comment for the September 20 meeting:

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.

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    Training and technical assistance

    Do not send paper claims, provider enrollment or prior authorization information to DHS offices or OHP Customer Service

    Please send documents from fee-for-service OHP providers only to addresses listed in the Provider Contacts List or the EDMS Coversheet:

    • Paper claims: PO Boxes listed in the Provider Contacts List
    • Prior authorization requests: 503-378-5814 (routine) or 503-378-3435 (for 24- or 72-hour response) as listed on the EDMS Coversheet
    • Provider enrollment forms: 503-378-3074, as listed on the EDMS Coversheet

    Sending documents to other addresses or fax numbers will delay processing. DHS addresses and fax numbers are not set up to accept or process provider documents.

    To learn more

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    Claims

    Fee-for-service physician-administered biologic drugs for autoimmune conditions will require prior authorization effective October 1, 2018

    Starting October 1, 2018, fee-for-service claims for physician-administered biologic agents for autoimmune conditions will require prior authorization (PA). If the claim does not have an approved PA, OHA will deny the claim.

    OHA will use the same PA criteria that already applies to pharmaceutical (patient-administered) claims for this class.

    To learn more
    To learn more about this change, please read OHA’s fax to Oregon prescribers.

    Fee-for-service claim reprocessing to apply 2018 GPCI values planned for September 7, 2018

    The weekend of September 7, OHA will reprocess all resource-based relative value scale (RBRVS)-priced fee-for-service claims with dates of service from January 1, 2018, through February 1, 2018, that were originally processed between January 1 and February 1 (and have not been adjusted since then).

    The reprocessing will correct overpayments caused by not applying the new 2018 Geographic Practice Cost Index (GPCI) values to claims during this time.

    OHA corrected this error on February 2, so that all RBRVS-priced claims processed or adjusted on and after February 2 processed correctly. 

     

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    Rules and program changes

    Recent rule revisions

    • 410-141-3000, 410-141-3010, 410-141-3041 - CCO Contract Renewal Notification and Recertification Requirements to Align with 2019 Contract Extensions
    • 410-200-0015 and 410-200-0240 - Implementing House Bill 3391 Reproductive Health and CAWEM Plus Postpartum Eligibility Period
    • 410-121-0040 - Amending Prior Authorization Approval Criteria Guide
    • 410-141-4020 - Clarifying How the Authority Administers Managed Care Entity Assessments, HB 2391, 2017 Legislative Session
    • 410-123-1220 - Correction of Date Error in Coverage According to the Prioritized List of Health Services

    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.