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Between March 2020 and April 2021, some Oregon Health Plan (OHP) providers will be asked about Oregon Medicaid and Children's Health Insurance Program claims paid between July 1, 2019 and June 30, 2020, as part of the Centers for Medicare & Medicaid Services (CMS) Payment Error Rate Measurement (PERM) review.
NCI, Inc. will conduct this review for CMS, using a random selection of claims. If a claim for a service you rendered is selected for review:
- NCI will contact you by phone and send a letter.
- The letter will tell you what documentation to send, where to send it, and when.
- You will need to provide a complete copy of the medical records supporting the specific claim.
NCI will use this information to determine whether:
- The service was provided, medically necessary and properly coded, and
- The service was paid in compliance with state policy.
For more information about PERM, see the CMS PERM website and Provider Education FAQs.
Questions?
Email PERMproviders@cms.hhs.gov or your State PERM Representative, Barbara Key at barbara.key@dhsoha.state.or.us.
Medicare now covers acupuncture for lower back pain
Medicare will cover up to 20 acupuncture visits per year to treat chronic low back pain under the following circumstances:
- The chronic low back pain (cLBP) must last 12 weeks or longer; be nonspecific (have no identifiable systemic cause); not be associated with surgery; and not be associated with pregnancy.
- For up to 12 visits in a 90-day period. Medicare will cover an additional eight sessions for patients demonstrating an improvement. Treatment must be discontinued if the patient is not improving or is regressing.
To learn more about this coverage decision, read the memo from the Centers for Medicare & Medicaid Services.
Changes to National Diabetes Prevention Program billing effective Jan. 1, 2020
Providers can now bill for National Diabetes Prevention Program (DPP) services as follows for services provided on or after January 1, 2020:
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For in-person services, use CPT code 0403T. If providing telehealth services, add modifier GT; bill $23 per session.
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For online services, use CPT code 0488T. Bill $49 per 30-day period.
To learn more, read OHA's updated fact sheet about National DPP reimbursement.
Use the current Prior Authorization Request form with coversheet
The MSC 3971 highlights all required fields, and includes the EDMS Coversheet for processing. Please only use this version of the form with the EDMS Coversheet as page 1.
When sending documentation for an existing PA request, be sure to include the PA number of the request you are sending documentation for. Otherwise, the documentation will be processed as a new PA request and will delay review of your existing PA request.
Only send paper claims to OHA's central PO Box
Except for Death with Dignity claims, all paper claims less than a year old now go to the following PO Box:
PO Box 14955
Salem OR 97309
Please do not send claims to local DHS offices; they will be returned to you.
To find current fee-for-service contact information for Oregon Medicaid providers, view OHA's Provider Contacts List.
Go paperless! Submit claims and PA requests online
Oregon Medicaid providers can go to https://www.or-medicaid.gov to submit claims and PA requests for direct entry into OHA's claim system.
If you submit claims for other payers through a clearinghouse, your clearinghouse may already work with OHA and be able to submit claims on your behalf. To learn more, view OHA's Electronic Business Practices page.
Learn how to make sure your patients count in the 2020 Census: Join the Census 101 webinar on Wednesday, Mar. 4
Every 10 years, the U.S. census collects data that informs our federal government about the resources and funding each state needs. The same data determines how many Oregon Representatives we have in Congress, making it vital to our democracy.
We Count Oregon, the Governor's State Census Project and OHA's Community Partner Outreach Program are hosting two webinars to share information about :
- The upcoming U.S. census and why it matters
- How to engage with state and local partners to spread the word to Hard-to-Count populations and areas of Oregon
The webinar will also share resources to help you develop plans and messages to promote getting every person counted in your community.
Join the webinar in English or Spanish on Wednesday, Mar. 4:
Free, quick online tobacco cessation counseling training (with CME) through OHA Transformation Center
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What: This short online course will improve your care team’s ability to help patients quit tobacco. The course focuses on Brief Tobacco Intervention and Motivational Interviewing techniques.
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Who: All members of the care team committed to supporting their patients to quit tobacco.
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When: The course is self-paced and takes approximately 45 minutes. The course can be started, paused and resumed later as needed.
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CMEs: This training has been reviewed and is accepted for up to 1.0 prescribed credit from the American Academy of Family Physicians (AAFP). For other licensing boards that may not pre-approve continuing education credits (for example, the Board of Licensed Professional Counselors and Therapists), please submit the certificate of participation to your accrediting body.
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Access the training: https://tcrc.rapidlearner.com/3462253711
Questions? Please contact Anona Gund (Anona.E.Gund@dhsoha.state.or.us or 971-673-2832).
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