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
Please submit fee-for-service claim adjustments and appeals electronically: As the pandemic continues, Oregon Health Authority (OHA) staff have limited staff working onsite to access mail, and mail service has also experienced delays. For faster processing of claim adjustments and appeals, please send them electronically to OHA.
- Scan the claim, save it as a PDF and send via secure email to OHA.FFSOHPClaims@dhsoha.state.or.us.
- This will also allow staff to communicate directly with the submitter via email to explain any issues with the claim such as missing information or other errors.
You can also adjust and resubmit claims online using the Provider Web Portal at https://www.or-medicaid.gov. To learn more, visit the Oregon Health Plan (OHP) Provider Web Portal page.
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.
The guide has been updated to include information about:
- Billing for COVID-19 booster doses for ages 12-15 (pages 8 and 43).
- OHA coverage of federally supplied oral antiviral medications to treat COVID-19 (pages 15 and 49).
Updates for all health care providers
New:
Updated:
Applications due Friday, Jan. 28, 2022
The COVID-19 pandemic has stretched Oregon’s public health and health care system beyond normal capacity. As a result, OHA is creating the Oregon Resource Allocation Advisory Committee to advise the agency on making important decisions about how resources are allocated across the health system.
OHA is looking for broad representation from the community and health system partners, such as:
- Organizations and community members who can represent community needs, especially communities of color, Oregon Tribal Nations, and people with disabilities, including people with intellectual and developmental disabilities.
- Partners engaged in Oregon’s health care delivery system, such as hospitals, healthcare providers and local public health.
As a committee member, your role would be to:
Interested in applying?
Email a completed committee application form by Jan. 28, 2022 to OHAResourceallocation@dhsoha.state.or.us.
Logistics and accessibility
- The committee will start in late February and meet over the next nine to twelve months. Meetings will be approximately every three weeks and held by Zoom.
- All meetings will be recorded.
- All meetings will have Automated Speech Recognition (ASR) enabled and ASR transcripts will be available after meetings by request.
- OHA will provide reasonable accommodations for individuals with disabilities or individuals who speak languages other than English. Some examples of accommodations are: Sign language, spoken language interpretation, real-time captioning, braille, large print, audio and written materials in other languages.
Determination deadline for trial-related prior authorization requests
Providers submitting fee-for-service prior authorization (PA) requests for OHP-covered services related to trial interventions are now required to mark their request for “Urgent” (not "Immediate" or "Routine") processing.
This lets OHA know that the request should be expedited to meet the 72-hour timeline recently established by the Centers for Medicare & Medicaid Services for coverage determinations related to qualifying clinical trials, effective Jan. 1, 2022.
To learn more about submitting PA requests to OHA, visit the OHP Prior Authorization page.
Change log for Jan. 1, 2022 Prioritized List of Health Services
The Health Evidence Review Commission posted a Change Log for the January 1, 2022 Prioritized List of Health Services.
Questions? Please email HERC.Info@dhsoha.state.or.us.
Recent rule revisions
OAR 410-120-1990 - Amends Overarching Telemedicine Rule Authorizing Coverage Of Remote Health Care Services Delivered Using Telecommunication Technologies
OAR 410-123 - Multiple Fee-for-Service Dental/Denturist Services Rules
OAR 410-130-0015 - Amends Doula Services Rule, Clarifies Doula Requirements And Coverage Of Services For Oregon Medicaid Beneficiaries
OAR 410-130-0200 - Removes Second Bariatric Surgery Request, Continues Prior Authorization Extension to 38 Weeks for Community Births
OAR 410-141 - Semi-Annual CCO Rule Updates and New Rules on Information Security and Restricted Reserves
OAR 410-170-0110 - Update the Effective Date of the BRS Tate Table
OAR 410-172-0670 - Changes Required to Support the SPA and 1115 SUD Waiver Demonstration Project
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