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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
Administration of COVID-19 bivalent booster and seasonal flu vaccines: Providers may administer both vaccines during the same encounter.
Read the memo from the Oregon Health Authority (OHA) to view the billing codes and links to OHA immunization protocols.
Face-to-face assessments for individuals who receive 1915(i) and Behavioral Health Personal Care Attendant (BH PCA) services begin October 15, 2022: Comagine Health, OHA’s current Independent and Qualified Agent (IQA), will no longer perform assessments for 1915(i) or BH PCA program services over the telephone. Instead, Comagine Health must complete all assessments in person or via videoconference.
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For telehealth requirements, see Oregon Administrative Rules (OARs) 410-172-0850 and 410-120-1990.
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For 1915(i) requirements, see OAR 410-173-0020.
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For BH PCA requirements, see OAR 410-172-0830(2). OHA will extend use of
videoconferencing for BH PCA assessments until the end of the COVID Public Health Emergency (PHE).
To learn more, please read the memo from OHA.
Please continue to refer to the Oregon Medicaid COVID-19 Provider Guide for information related to Oregon Health Plan (OHP) and Citizenship Waived Medical (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.
Letters to OHP and Medicare Savings Program (MSP) members
Starting Sept. 26, 2022, OHA and Oregon Department of Human Services (ODHS) are mailing reminders to OHP and MSP members about updating their contact information. The mailing will run through mid-November.
The purpose of the letters is to:
- Encourage people to update their contact information so they can receive important information about their benefits now and especially once the COVID-19 PHE ends. It includes a list of options for updating contact information.
- Identify people who are not receiving mail from us so we can reach out and update their contact information before the COVID-19 PHE ends. We will use the returned mail information to support broader efforts to update addresses for those receiving benefits.
How you can support people receiving benefits:
You may receive questions about these letters. Please help us by encouraging people to:
- Verify or update their contact information or
- Report any changes using the options provided in the letters.
People receiving benefits can also visit Oregon.gov/OR-benefit-changes to:
- Verify the letter they received and
- Access options they can use to update their information.
Also be sure to keep informed about efforts related to the end of the COVID-19 PHE by visiting the links below.
Reminders and best practices related to member billing prohibitions
Oregon Medicaid providers cannot bill Medicaid (OHP or CWM) members for:
- Covered services, except for certain limited situations outlined in Oregon Administrative Rule (OAR) 410-120-1280,
- Missed appointments,
- Covered services that, due to provider error, were not paid (e.g., you did not submit required documentation, obtain prior authorization, or bill correctly), or
- Any charges remaining (“balance bill”) after receiving payment from OHA, the member’s coordinated care organization (CCO), dental plan, Medicare and/or a third party liability insurer, even if the payment is a “zero payment.” Such payments are considered “payment in full.”
Efforts to collect payment in these instances violate OHA’s Provider Enrollment Agreement (OHA 3975), OAR 410-120-1280 and state law (Oregon Revised Statute 414.066). To avoid this, please follow these best practices:
- Ensure front line staff verify all insurance sources.
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Check for Medicaid (OHP or CWM) eligibility before sending a billing issue to collections. Even if you have checked before, check again.
- Some members can have their eligibility backdated up to 90 days before their original approval date for OHP or CWM.
- Eligibility can be updated or corrected at any time.
- If the member is eligible, then the next step is to bill OHA or the member’s CCO. OHA accepts claims up to one year after the original service date.
- For non-covered services, make sure an Agreement to Pay is completed, discussed with the patient and on file before providing the service. OHA has three different forms you can use:
- Please respond quickly if OHA or your CCO notifies you about a member being billed for covered services. Be prepared to file a claim for the date of service in question.
Thank you for helping protect members from unnecessary or inappropriate health care bills.
 Provider updates
Provider resource updates
 Recent rule revisions
OAR 410-121-0030, 410-121-0040: Amending PDL DUR/P&T Actions and Prior Authorization Approval Criteria Guide effective 100122
OAR 410-141-3830: Incorporate the October 2022 Prioritized List of Health Services For The Oregon Health Plan
OAR 410-123-1510, 410-140-0020, 410-140-0040, 410-140-0050, 410-140-0140, 410-140-0200: Vision And Dental Benefits Update, Removal Of Outdated Language, And Benefit Clarification
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