Provider Matters - November 30, 2018

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

November 30, 2018

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In this issue ...

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Important reminders

The Chronic Pain Task Force meets December 5, 2018

On December 5, the Chronic Pain Task Force will consider additional information and how it may impact their recommendation to the Health Evidence Review Commission (HERC). The agenda includes:

  • Review opioid tapering evidence evaluation by Oregon Health & Science University’s Center for Evidence-based Policy;
  • Review results of coordinated care organization (CCO) survey about previous back and neck pain coverage changes and other potential coverage changes related to chronic pain;
  • Review and discuss potential alternatives to task force proposal; public comment will be accepted for 30 minutes starting at about 11 a.m..

To keep informed:
Visit the HERC website for meeting schedules, agendas and materials.

To comment on proposed changes:
Send written comments to HERC will receive verbal comments in person at the meetings.

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Training and technical assistance

No updates at this time.

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Change to sterilization consent requirements effective 1/1/2019

Starting January 1, 2019, the Oregon Health Authority (OHA) will no longer require a sterilization consent form for procedures that are unrelated to voluntary sterilization but would result in sterilization (such as ovarian cancer surgery). This means:

  • Providers will no longer need to collect a consent form for procedures that cause sterilization if the purpose of the procedure is something other than sterilization.
  • OHA will still require consent when the purpose of the procedure is sterilization.

Starting January 1, some claims will process without suspending for a consent form. However, some claims will continue to suspend for additional information, such as chart notes. In these cases, providers will need to submit documentation that shows:

  • The patient’s reproductive capacity remained intact after the procedure, or
  • The patient was sterile before the procedure, or
  • The purpose of the procedure was to treat illness/injury and not to cause sterilization.

To learn more about OHA’s sterilization consent requirement, see Oregon Administrative Rule 410-130-0580.

Ambulatory surgical centers can bill OHA for post-procedure long-acting reversible contraceptive placement effective 1/1/2019

Starting January 1, 2019, OHA will pay for long-acting reversible contraceptive (LARC) placement provided in an ambulatory surgical center (ASC) to Oregon Health Plan (OHP) members not enrolled in a CCO for physical health care.

  • This means ASCs will be able to bill OHA fee-for-service for LARC placement the same as clinics, hospitals, and other settings.
  • LARC placement includes IUDs and subdermal implants.
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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 issuesContact Provider Services at 800-336-6016 (option 5).
  • EDI and the 835 ERAContact 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 resetsContact Provider Services at 800-336-6016 (option 5). 

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