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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
Novavax COVID-19 vaccine administration for ages 12 and older, effective 8/22/2022: First dose (0041A) and second dose (0042A) may be billed for ages 12 and older effective 8/22/2022. The age limit was previously 18 years and older effective 7/19/2022.
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.
 Partner webinar series about preparing for the end of the federal COVID-19 Public Health Emergency now starts Sept. 20, 2022
Please help share this learning opportunity with community partners, coordinated care organizations, providers, insurers, and others who work with Oregon Health Plan (OHP) members or people who receive Oregon Department of Human Services (ODHS) benefits.
- These monthly webinars will provide information and tools that partners can use to help OHP members and people who receive ODHS benefits prepare for potential changes once the federal COVID-19 Public Health Emergency ends.
- Sessions will be Tuesdays, 10 to 11 a.m. Pacific Time starting Sept. 20, 2022.
Reminder: Bill Oregon Health Plan (OHA or the CCO) last
Federal law requires that state Medicaid agencies take all reasonable measures to ensure that in most instances, Medicaid is the payer of last resort. Providers must make reasonable efforts to obtain payment first from other resources. This includes:
- Determining all the patient's health coverage resources (e.g., private insurance, worker's compensation, Medicare) on each date of service.
- Billing the patient's other resources (private insurance, worker's comp, Medicare) before billing Medicaid. When coordinating benefits, Medicaid should be listed after all other resources.
When you bill the Oregon Health Authority (OHA) for services, OHA will generally make payment only when other resources do not cover the service. Full use must be made of all other available resources.
If you make reasonable attempts to bill other resources and they deny the service as not covered, or adjudicate the amount to a deductible:
- First, appeal the denial.
- When billing OHA, include the valid two-digit third party resource code that explains why the other resources did not pay.
- Sending the other resource's Explanation of Benefits (EOB) is helpful but does not replace the need to provide the two-digit code to OHA.
 Oct. 1, 2022 Prioritized List of Health Services now available
The Health Evidence Review Commission has posted the Oct. 1, 2022 Prioritized List of Health Services. The changes in the pending list include technical changes, changes to accommodate advancements in technology and changes made due to new evidence on the effectiveness or ineffectiveness of treatments.
OHA will review these changes. If the changes are found to be within the List's current funding level, OHA will determine the effective date for these changes, which will be no earlier than October 1, 2022, pending approval from the Centers for Medicare & Medicaid Services.
 CCO-F: DCO members moving to CCOs, effective Jan. 1, 2023
Approximately 69,000 OHP members who are enrolled in dental care organizations (DCOs) will transition to a new CCO plan type. Starting Jan. 1, 2023, these members will move to CCO-F plans. CCO-F plans will include dental services, non-emergent medical transportation, and care coordination services.
Letters with more information will be mailed to members on October 3, 2022. Copies of these letters are available on the DCO Transition page.
With this transition, OHA’s goal is to ensure there is as little member disruption as possible. Because of existing contractual relationships, most members can continue to see their current providers. There will also be a 90-day transition period for any members whose new CCO does not work with their current provider.
In some areas, members will have a choice between two or more CCO plans. Members can use the CCO plan tool to compare available plans or call OHP Client Services at 800-273-0557 (TTY 711) for help.
Questions? Please reach out to HSD.QualityAssurance@odhsoha.oregon.gov.
 Fee-for-service reprocessing of neonatal and pediatric intensive care service professional claims planned for week of Sept. 12, 2022
Next week, OHA will reprocess all professional services claims paid from Jan. 1, 2022, through Aug. 30, 2022, to apply the fee-for-service rate increase for procedure codes 99468 through 99480.
- You will see this activity on outgoing remittance advices starting Tuesday, Sept. 13.
- No action is required on your part.
 Recent rule revisions
OAR 410-141-3830: Incorporate the October 1, 2022 Prioritized List of Health Services for the Oregon Health Plan
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