Provider Matters - September 28, 2018

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

September 28, 2018

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In this issue ...

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Important reminders

Changes to the Prioritized List of Health Services effective 10/1/2018

The Health Evidence Review Commission (HERC) has updated the Prioritized List of Health Services and guideline notes, effective October 1, 2018. Changes include:

  • Code changes resulting in 459 new diagnosis/procedure pairs and 714 deleted pairs (mostly due to implementing the 2019 ICD-10-CM code set)
  • 5 new guidelines, 18 revised guidelines, and 1 deleted guideline
  • 5 new coding specifications
  • New statement of intent on the treatment of chronic pain
  • Revised statement of intent on palliative care

The Oregon Health Authority (OHA) has updated its claim system to reflect these technical changes, effective October 1, 2018.

To learn more
Visit the HERC website. A full description of the October 1 changes is available in HERC’s Notification of Interim Changes.

To be informed when HERC announces pending changes to the Prioritized List, sign up for HERC email updates.

Task force to evaluate additional information regarding chronic pain, opioids

The Chronic Pain Task Force met on Sept. 20 and received a briefing on the public comments received so far on its proposal to expand non-pharmacological treatment for certain chronic pain diagnoses, while limiting long-term opioid therapy. The task force also received additional in-person testimony.

In response to the concerns heard from patients and providers OHA:

  • Amended the makeup of the Chronic Pain Task Force to strengthen its expertise;
  • Solicited expert testimony;
  • Requested an updated evidence review on opioid tapering by Oregon Health & Sciences University; and
  • Will request input from CCOs through a survey.

In December, the task force will have the opportunity to receive and consider these new pieces of information and how they may impact their recommendation to the Health Evidence Review Commission.

For more information, please contact the HERC staff at

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    Training and technical assistance

    Coming soon: Session expiration message in Provider Web Portal

    Beginning October 8, 2018, Provider Web Portal users will have two ways to find out when their session is about to expire.

    • The top of the screen will show the date and time your session will expire.
    • After 15 minutes of inactivity, you will get a pop-up message that reads, “Your session is expiring at [date/time]. Click here to extend your session.”

    As a reminder, clicking on a search, add or save button is considered an activity. Any activity, including clicking on the pop-up link, extends your session for another 20 minutes.

    To learn more
    Read our fact sheet about this change.

    How to fax prior authorization requests to OHA

    The Oregon Health Authority (OHA) will only accept prior authorization requests in two ways:

    • 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.
    • Online: Using the Provider Web Portal at This is the preferred way to submit requests.

    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.

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    Prescriber enrollment requirement postponed to November 13, 2018

    Due to an unexpected volume of provider enrollment applications in late August, OHA will require the Prescriber ID on pharmacy claims to belong to an enrolled Oregon Medicaid provider starting November 13, 2018 (not September 1).

    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.

    Enrolling prescribing providers
    To prepare for this change, please be sure that your prescribers are enrolled with OHA.

    Entering the prescriber ID on pharmacy claims
    Electronic claims will require the prescriber’s National Provider Identifier (NPI). Paper claims require both the NPI and Oregon Medicaid ID issued by OHA.

    Please do not enter other values, such as taxonomy codes or UPINs, in provider ID fields. Claims that contain any values other than NPI and/or Oregon Medicaid ID may be denied.

    To learn more

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    Rules and program changes

    Recent rule revisions

    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.