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
Status of fee-for-service claims for COVID-19-related services to CAWEM members: The Oregon Health Authority (OHA) has found the following issues with processing fee-for-service (FFS) claims for COVID-19-related services to CAWEM members:
- OHA's claims system is not processing pharmacy claims for COVID-19 vaccine administrations for payment. These claims will not display on the remittance advice. In the Provider Web Portal, these claims have a "Paid" status with no paid date or paid amount.
- The system is also denying outpatient claims for COVID-19 testing as a non-covered service.
These issues only affect claims billed for members with the CAWEM (CWM) benefit package. Other benefit packages are not affected. OHA is working to resolve these issues as soon as possible.
In the meantime, OHA encourages all providers to continue providing, and billing for, covered COVID-19-related services to OHP and CAWEM members. To learn more, please read the April 22 announcement from OHA.
Please continue to refer to the Oregon Medicaid COVID-19 Provider Guide for information related to OHP and CAWEM coverage of vaccine, 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
Updated:
New:
The OHA Transformation Center, in partnership with the OHA Vaccine Planning Unit, is hosting a learning collaborative for clinics newer to COVID-19 immunizations to learn from subject matter experts and health center peers.
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Topics: OHA will cover topics such as operational workflows, allocations, targeting high risk populations, vaccine hesitancy and more.
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Audience: FQHC staff and clinical staff new to COVID-19 vaccine administrations
All sessions are Fridays, from noon to 1 p.m.
FFS coverage of travel to administrative medical examinations
OHA honors the OHP 729B (Administrative Medical Examination Transportation Request) as confirmation of FFS coverage to schedule non-emergent medical transportation (NEMT) rides to administrative medical examination appointments.
- The administrative medical examination is a medical or psychological evaluation required by the Oregon Department of Human Services (ODHS), OHA or Oregon Youth Authority (OYA) to support eligibility determination and casework planning for various programs (OAR 410-150-0010).
- The ODHS, OHA, or OYA office requesting the examination will request NEMT by emailing the completed OHP 729B to the recipient’s local FFS NEMT brokerage. Only FFS brokerages may provide rides to administrative medical examinations.
To learn more, please read the April 8 announcement from OHA.
Recent rule revisions
410-121-0040 - Amending Prior Authorization Approval Criteria Guide
410-200-0520 - Aligning with CMS Guidance on Eligibility and Enrollment During the COVID-19 Public Health Emergency
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