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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
No updates at this time.
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.
 New COVID-19 provider funding opportunities open for applications Sept. 29
On Sept. 29, 2021, health care providers will be able to apply for $25.5 billion in relief funds, including $8.5 billion in American Rescue Plan resources for providers who serve rural patients and $17 billion for Provider Relief Fund Phase 4 for a broad range of providers who can document revenue loss and expenses associated with the pandemic.
In order to streamline the application process and minimize administrative burdens, providers will apply for both programs in a single application and HRSA will use existing Medicaid/CHIP and Medicare claims data in calculating portions of these payments.
Phase 4 General Distribution — $17 billion based on providers’ lost revenues and changes in operating expenses from July 1, 2020 to March 31, 2021. To promote equity and to support providers with the most need, HRSA will:
- Reimburse a higher percentage of lost revenues and expenses for smaller providers as compared to larger providers.
- Provide "bonus" payments based on the amount of services they provide to Medicaid, CHIP, and Medicare patients, priced at the generally higher Medicare rates.
American Rescue Plan (ARP) Rural — $8.5 billion based on the amount of services providers furnish to Medicaid/CHIP and Medicare beneficiaries living in Federal Office of Rural Health Policy (FORHP)-defined rural areas.
- To promote equity, HRSA will price payments at the generally higher Medicare rates for Medicaid/CHIP patients.
 Updates for all health care providers
- Vaccine requirements for health care providers and health care staff:
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Minor Testing Consent form now available in Spanish, Arabic, Traditional Chinese, Simplified Chinese, Chuukese, Hmong, Korean, Marshallese, Russian, Somali, Vietnamese
- Testing info printable flyer now available in Korean, Somali, Spanish, Arabic, Traditional Chinese, Simplified Chinese, Chuukese, Hmong, Marshallese, Russian, Vietnamese
- Monoclonal antibody therapy:
- Other updates:
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Behavioral Health Support for Health Care Workers (8/26/2021) now available in Simplified Chinese and Marshallese
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Hospital Support Persons flyer (8/24/2021) now available in Spanish, Arabic, Traditional Chinese, Simplified Chinese, Chuukese, Hmong, Korean, Marshallese, Russian, Somali, Vietnamese
New audiology code open for fee-for-service payment
The Oregon Health Authority (OHA) has opened code 92650 (Screening evaluation of brain response to sound with automated analysis) for fee-for-service payment. Providers can learn more about billing and reimbursement for audiology services on the Speech-Language Pathology, Audiology and Hearing Aid Services rules and guidelines page.
Oregon Health Plan provider appeals processes
If you disagree with a payment decision related to claims you submitted to the member's coordinated care organization (CCO) or OHA, please follow the processes described below and review the Oregon Administrative Rules (OARs) listed below for more information.
For claims billed to the CCO, you must first appeal the decision with the CCO. If you still disagree with the decision after completing the CCO's appeal process, you can request an administrative review from OHA. To do this, send the following via secure email to OHA.AdministrativeReview@dhsoha.state.or.us:
- A completed OHP 3085 (Request for Claim or Payment Authorization Review). Fill out all relevant fields, including decision date, reasons for review, and supporting documentation;
- A copy of the original claim;
- A letter from CCO stating why the appeal was denied;
- A letter to OHA stating why the denied appeal should be overturned; and
- All relevant chart notes or information a medical professional will need to review the case. Do not submit the entire medical record.
For claims billed to OHA, send the following via secure email to OHA.FFSOHPClaims@dhsoha.state.or.us:
- A completed OHP 3085 (Request for Claim or Payment Authorization Review). Fill out all relevant fields, including decision date, reasons for review, and supporting documentation;
- A copy of the original claim;
- A letter to OHA stating why you disagree with the claim denial; and
- All relevant chart notes or information a medical professional will need to review the case. Do not submit the entire medical record.
Recent rule revisions
OAR 410-120-1260 - Requiring OHP Enrolled Providers Review the Prescription Drug Monitoring Program (PDMP) Before Prescribing Controlled Substances
OARs 410-172-0600, 410-172-0710, 410-172-0775, 410-172-0780, 410-172-0790, 410-172-0795, 410-172-0800, 410- 172-0810, 410-172-0820, 410-172-0830, 410-172-0840 - Update Medicaid Behavioral Health OARs to Reflect Required Program Changes for Personal Care Services
OAR 410-200-0215 - Amending Administrative Rule to Align with Federal Changes Related to COFA Citizens
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