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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
Fee-for-service reimbursement of COVID-19 self-collected, self-administered test kits provided by non-pharmacy providers: Effective immediately, the Oregon Health Authority (OHA) now allows the following providers to bill OHA for FDA-approved, self-collected COVID-19 home test kits supplied to fee-for-service members on or after April 4, 2022.
- Coordinated care organizations (CCOs) may choose to do the same as OHA, but they do not need to do this if pharmacies provide sufficient member access to COVID-19 home test kits.
- OHA will cover up to 8 tests per month without prior authorization or a physician’s order, at $12 per test.
To learn more, read the memo from OHA.
Please continue to refer to the Oregon Medicaid COVID-19 Provider Guide for information related to OHP and CWM coverage of vaccine, testing, screening, treatment and telemedicine services; OHP and CWM eligibility; and other information and resources related to providing and billing for covered services during COVID-19.
The guide now includes:
- Pediatric vaccine administration codes for ages 6 months and up
- Novavax vaccine administration codes
- Updated home test kit information
 Novavax fact sheets
Available in English, Spanish, Arabic, Chuukese, Hmong, Korean, Marshallese, Portuguese, Russian, Simplified Chinese, Somali, Traditional Chinese, Vietnamese
Vaccine Learning Series: Join OHA's Aug. 18 webinar
Join OHA's latest session in its learning series to support the COVID-19 vaccine rollout for the 6-month through 5-year old populations.
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Topic: Developing a Positive Immunization Culture in Clinical Practice
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Description: In this session, OHA staff and clinical partners will share strategies that encourage immunization through policies and practices that reduce barriers and increase the rate of timely and complete vaccination. Presenters will discuss a team-based approach and how it can help promote an atmosphere in which vaccines are expected and welcomed.
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Date and time: Aug. 18, 9 to 10 a.m.
- Link to register
If you require an accommodation to fully participate in the learning session, please contact Tom Cogswell (971-304-9642).
If you have questions about specific session content, please contact Jill Johnson or Irma Murauskas.
Be sure to also view the recordings from past webinars in this series:
Provider billing and member reimbursement for retroactive OHP Supplemental benefits
To reimburse OHP members who paid your office for OHP Supplemental benefits now retroactively covered, please be sure to bill the member’s CCO, dental care organization (DCO), or OHA as follows:
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By Nov. 30, 2022, for services provided June 2, 2021, through Nov. 30, 2021, and
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Within 365 days of the date of service for services provided on or after Dec. 1, 2021.
For any OHP member who paid your office for services that OHP would have covered during their period of retroactive 12-month eligibility:
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Verify eligibility, obtain service authorization as appropriate, and bill the appropriate payer (the CCO, DCO or OHA) for covered services. Refer to OHA’s fact sheet for details.
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Refund the member the full amount they paid for the approved services. Do this even if the amount the member paid is more than the amount the CCO, DCO, or OHA would pay.
To learn more, please read the memo from OHA.
Reminder: Hospital inpatient reporting process
Please report all hospital inpatient information via secure email to ces.dmap@oregon.gov.
- OHA does not accept this information via fax. This is to protect members' private information in compliance with federal Health Insurance Portability and Accountability Act of 1996 (HIPAA) security requirements.
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Secure email requires all users to provide password authentication to access the email.
Please only include the following information within your report:
- Full name
- Prime number
- Date of birth
- Admission date
- Discharge date
- For patient transfers after hospitalization, include facility type
OHA does not need the patient’s personal medical information typically found on the hospital admit sheet. Please do not include this information in your secure email to ces.dmap@oregon.gov.
Provider resources
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