CCO 2.0 provider resource updates
Based on questions we have received, the CCO 2.0 provider resources page now contains quick links to:
- The Jan. 1, 2020 CCO sample contract and Division 141 Oregon Administrative Rules, which explain OHA's requirements for contracted CCOs; and
- Links to the Health Share of Oregon site, for providers seeking information about changes to Health Share's network of physical health plans, and how to verify a member's physical health plan.
Do you know someone who would benefit from this information? Please share it!
Reminder: Do not bill members for services approved by the member's 2019 CCO
The member's 2020 CCO is required by contract to provide all services approved by the member's 2019 CCO for 180 days or through June 30, 2020. During this time:
- Please provide the service and bill the member’s 2020 CCO.
- Do not bill members, or have them sign an Agreement to Pay form, for approved services.
- State and federal laws prohibit billing members for services that Medicaid covers.
To continue providing this service after June 30:
Providers need to get approval from the member's 2020 CCO. Contact the CCO for their specific authorization timelines, policies and processes. If the CCO denies the service:
- Appeal the decision with the CCO as instructed in their denial letter (Notice of Action/Benefit Denial).
- If the CCO upholds the original decision, appeal to OHA through the administrative review process.
At the same time, the member can also appeal the CCO's decision, then ask OHA for a state fair hearing.
When can providers complete an Agreement to Pay form with a member?
Providers should only ask members to complete an Agreement to Pay form for services that are never covered by the Oregon Health Plan (OHP), such as:
Effective January 1, 2020, OHP now covers the following services to treat craniofacial anomalies (ICD-10 codes M95.2, Q67.4, Q75.0-Q75.9, and Q87.0):
- D0364-D0367
- D7111-D7240
- D7280
- D7283
- D8010-D8690
- D8696-D8704
To learn more about this change, read OHA's January 23 announcement and updated Dental Services Provider Guide.
If you bill OHA for physical, occupational or speech therapy services to OHP members, please remember that these services no longer require prior authorization. Instead, OHA now reviews submitted claims to ensure they meet payment criteria.
To learn more, review the current rules and guidelines on the OHP website:
If you have questions about billing, please call Provider Services at 800-336-6016 (Option 5).
OHA is forming a Rules Advisory Committee (RAC) for the Administrative Examinations program (Division 150), and is seeking participation from providers who have billed OHA for administrative examinations requested by OHA, the Department of Human Services (DHS) and Oregon Youth Authority (OYA).
- Administrative examinations are medical or psychological evaluations used to determine eligibility for various programs.
- The RAC will inform future rulemaking decisions for the program.
If interested in participating, please email Napua Rich by March 1, 2020.
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