As we work together to stop the spread of COVID-19 at home, work and in the community, we want to make sure you have the resources you need to keep informed, healthy and safe. If you have any questions about OHP and COVID-19, please let us know.
Updates for Oregon Health Plan providers
The Oregon Medicaid COVID-19 Provider Guide and OHP COVID-19 Vaccine Fact Sheet now include billing information for the Johnson & Johnson/Janssen COVID-19 vaccine.
Please continue to refer to the Oregon Medicaid COVID-19 Provider Guide for information related to OHP and CAWEM coverage of testing, screening, treatment and telemedicine services; OHP and CAWEM eligibility; and other information and resources related to providing and billing for covered services during COVID-19.
Updates for all health care providers
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If you work with expectant mothers, please help fee-for-service OHP and CAWEM Plus members make sure their baby’s health care provider works with their local coordinated care organizations (CCOs).
- Once the birth of a newborn is reported to OHP, they are automatically assigned to a local CCO about two weeks later. As a reminder, providers can assist the member with reporting the birth of a newborn to OHP by completing the Newborn Notification form.
- If the baby's provider only accepts fee-for-service members, or does not work with the baby’s CCO, this can disrupt the baby's care and cause potential billing issues.
During prenatal care visits and at the hospital, please share information about the importance of choosing both a provider and CCO that will work best for the newborn and family.
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Members can view CCO information and provider directories at bit.ly/ccoplans to see if the baby's provider works with the CCO(s) in their area.
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If the baby's provider works with a local CCO, members can call OHP Client Services at 800-273-0557 to ask for that CCO for their newborn. This can take up to two weeks, so families should ask for this as soon as possible after the baby is born. In areas with more than one CCO, this is especially important if the baby's provider only works with one of the CCOs. Learn more about changing CCOs in OHA’s fact sheet.
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If the baby's provider does not work with a local CCO, the member needs to find a new provider in the CCO's network. The provider should contact the CCO to learn about joining the CCO's network or how to get reimbursed for services provided.
If you need to bill for services to OHP newborns, verify the newborn's eligibility and enrollment. CCO providers should wait until the newborn is enrolled with the CCO, then bill the CCO.
Sharing and acting on this information as early as possible can help keep the baby's birth a less stressful and more joyful time. You can also find other resources for expectant mothers on the Public Health Division website.
March 17 through June 16, 2021 webinar series
Join us this spring for an informative, engaging, and practical webinar series on value-based payment (VBP) developed specifically for Oregon’s providers.
As state and federal programs shift from volume-based to value-based payment, providers must make critical adjustments to prepare for and succeed under VBP contracts. This five-part webinar series will help practices and agencies as they prepare for VBP contracts.
- Sessions are from noon to 1 p.m., starting March 17 and ending June 16, 2021.
- The series will provide an overview of VBP models as they apply to the Oregon landscape and how they can support providers to improve patient outcomes through more comprehensive and flexible approaches to delivering health care.
- The sessions are intended to enhance primary care, behavioral health, and maternity care providers’ readiness for VBP and help them take advantage of the additional flexibility VBPs offer so they can innovatively redesign care models.
View OHA's flyer for further details including available CME, full webinar descriptions and dates, as well as registration links for the 5-part series.
March 17 webinar: Evidence-based Strategies for Advancing Health Equity
Closing health equity gaps over the next decade will require applying specific strategies throughout facets of the health delivery system, including VBP.
At this 90-minute webinar, national expert Marshall Chin, MD, will help CCOs and other health system partners apply lessons from health care transformation and VBP models gleaned from systems throughout the U.S. to aid in reducing health disparities. To learn more about Dr. Chin and this presentation, view OHA's flyer.
Post-payment review for outpatient speech-language pathology, physical therapy and occupational therapy claims
Starting July 1, 2019, OHA replaced prior authorization of fee-for-service outpatient therapy services with prepayment review (PPR) of submitted claims. This change has been a success, allowing providers to start clinically appropriate therapy on time, without waiting for OHA approval.
OHA is making this a permanent process, with the following changes:
- Claims submitted will no longer suspend for payment. Instead, all claims will pay, making this a post-payment review process.
- OHA will review a random sample of claims to ensure they meet all documentation requirements.
Claims will continue to deny appropriately if services are not covered in the member's OHP benefit package, codes are not paired on the Prioritized List of Health Services, or for incorrect billing or provider type. To learn more, read OHA's PPR fact sheet.
Questions? Please email OHA.PPR@dhsoha.state.or.us.
Prepayment review of administrative examination and billing services begins April 1, 2021
Effective April 1, 2021, all claims for administrative examination and billing services will suspend for review. Staff will review these claims against OHP 729 authorizations from the referring agency. This change will ensure that OHA approves payment only for services authorized by the referring agency.
- Administrative examinations and billing services may be requested only by Oregon Department of Human Services (ODHS), Oregon Youth Authority or OHA.
- Administrative examination providers should only bill OHA for the specific procedure codes authorized by ODHS, OYA or OHA on the OHP 729 forms.
- Do not bill CCOs for these services; only bill OHA.
You can learn more about administrative examinations and related Oregon Administrative Rules on the OHA website.
Questions? Please email Medicaid.Programs@dhsoha.state.or.us.
Visual Services providers: Join OHA's new 2021 collaboratives
It's not too late to join! Learn more about OHP's fee-for-service Visual Services policies and coverage at these quarterly meetings, which began Tuesday, March 9 on Zoom.
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Day and time: Tuesdays, 10 to 11:30 a.m.
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Dates: June 8, Sep. 7 and Dec. 7, 2021
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Location: Microsoft Teams
If interested in this opportunity, please email NapuaAnn.K.Rich@dhsoha.state.or.us
Medicaid Electronic Health Records (EHR) Incentive Program
OHA is accepting Program Year 2020 attestations for the Medicaid EHR Incentive Program (also known as the Promoting Interoperability Program) until Wednesday, March 31, 2021.
Questions? Please call 503-945-5898 or email Medicaid.EHRIncentives@dhsoha.state.or.us.
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