Provider Matters - February 28, 2019

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

February 28, 2019

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In this issue ...

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Important reminders

Survey for Oregon Health Plan application feedback ends March 21, 2019

The Department of Human Services (DHS) and the Oregon Health Authority (OHA) have drafted a new Oregon Health Plan print application, which you can review until March 21, 2019 through an online survey.

Action required— Enroll prescribers with the Oregon Health Plan

To ensure continued prescription coverage for Oregon Health Plan members, OHA will not enforce the prescriber enrollment requirement for fee-for-service prescription claims on March 1.

  • Despite continued outreach, too many prescribers remain unenrolled.
  • When OHA has confirmed a new effective date, we will let you know.In the meantime, please help OHA’s outreach efforts by:
  • Sharing this requirement with your colleagues;

Enrollment does not require any provider to start serving Oregon Health Plan (OHP) members. However, it does ensure that the prescriptions they write for OHP members are covered.

How to enroll
To enroll with OHA, visit OHA's Provider Enrollment page.

To enroll with a CCO, contact the CCO.


  • About prescriber enrollment: Contact Provider Enrollment at 800-336-6016 (Option 6) or
  • About fee-for-service prescription claims: Contact the Pharmacy Call Center at 888-202-2126. This number is for providers only.
  • About CCO claims: Contact the CCO.
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Training and technical assistance

How to submit physical health prior authorization requests to OHA

OHA only accepts prior authorization requests in two ways:

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

To learn more about OHA’s current prior authorization process for physical health services, view training slides, questions and answers, and other resources on the OHP prior authorization page.

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Billing for maternity case management of CCO members effective April 1, 2019

Starting April 1, the Oregon Health Authority will no longer reimburse providers for maternity case management services to patients enrolled in a coordinated care organization for their physical health care.

  • For CCO members, bill the CCO only.
  • For members not enrolled in a CCO, please continue to bill OHA. 
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No updates at this time.

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Rules and program changes

Recent rule revisions

No updates at this time.

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.