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The Oregon Health Authority (OHA) has posted the following resources to help providers support Oregon Health Plan members during the transition to new coordinated care organizations (CCOs) in 2020.
You can find more resources, including forms, fact sheets, and contact information for 2020 CCOs on the CCO 2.0 information page for providers.
ICYMI: OHA approves AllCare, Cascade Health Alliance, Umpqua Health Alliance and Yamhill Community Care for full five-year CCO contracts
OHA has announced that these CCOs have met the necessary requirements to earn full five-year contracts to serve Oregon Health Plan members for 2020-2024.
The CCOs had to show they had policies, procedures and plans in place to meet the goals of CCO 2.0. OHA provided technical support to help the plans.
To learn more, read the Dec. 6 and Dec. 12 news releases from OHA.
The Health Evidence Review Commission has published the January 1, 2020 pending Prioritized List of Health Services, and a change log with error corrections. The list:
- Is 662 lines long, compared to the 660 lines on the previous list.
- Has a new funding level that covers lines 1-471, which corresponds to the same relative position of the funding level of the October 1, 2019 list.
- Contains technical changes due to new evidence on the effectiveness or ineffectiveness of treatments; the addition or removal of diagnosis and procedure codes, including new CPT and HCPCS codes; and restructuring of specific lines during the biennial review.
- Contains changes to practice guidelines and coding specifications, including a new informational statement about community health workers.
Questions? Email HERC.Info@dhsoha.state.or.us.
Update to Provider Web Portal "claim adjust" function
The Provider Web Portal at https://www.or-medicaid.gov no longer allows users to adjust claims older than 18 months. To adjust claims older than 18 months:
To learn more about adjusting paid claims, read OHA's Claim Adjustment Handbook.
Reminders about submitting paper claims
For paper claims:
- Do not enter NPI taxonomy numbers in the Provider ID field. OHA only accepts the NPI and Oregon Medicaid provider ID. The billing handbooks on the OHP Billing page list the field-specific requirements for paper claims.
- Mail claims to the PO Boxes listed in the Provider Contacts List. Do not fax claims to DHS field offices; they will be returned and not forwarded to OHA for processing.
Prior authorization tips and resources
OHA’s fee-for-service prior authorization (PA) requirements provide technical and clinical support for a consistent and objective PA review process. Routine PA requests are now being processed within two calendar weeks of receipt of a complete and reviewable submission. To avoid delays in the review process, please be sure to:
For a full overview of OHA’s process and to learn how to submit web portal requests, you can watch the video or view the slides from OHA’s webinar about how to submit fee-for-service physical health PA requests..
Use the Provider Web Portal to submit claims and PA requests electronically
To avoid issues submitting paper claims and prior authorization requests to OHA, use the Provider Web Portal at https://www.or-medicaid.gov. All you need is a current internet browser and internet connection. To learn more, visit the OHP Electronic Business Practices page.
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410-050-0861 - Type A/B Hospital Assessment Rate Updates effective 12/1/2019
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410-050-0861 - Type A/B Hospital Assessment Rate Updates effective 12/27/2019
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410-121-0040 - Amending Prior Authorization Approval Criteria Guide
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410-121-0030 - Amending Preferred Drug List
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410-125-0230 - Adding Language to Include DRG Hospitals in the Qualified Directed Payment (QDP) program
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410-120-1295 - MCE Rates for Non-Participating DRG Hospitals, effective 1/1/2020
Sign up to get rule updates via text or email
You can sign up to get text or email updates about:
- Notices of proposed rulemaking
- Temporary rulemaking notices
- Permanent rulemaking notices
To learn more, read about how to sign up for rulemaking notices.
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