Updates for Oregon Health Plan providers
None at this time.
Please continue to refer to the Oregon Medicaid COVID-19 Provider Guide for information related to Oregon Health Plan (OHP) coverage of COVID-19 vaccine, testing, screening, treatment and telemedicine services and other information and resources related to providing and billing for covered services related to COVID-19.
Review what is ending and continuing with the May 2023 end of the COVID-19 Public Health Emergency (PHE): View the May 2023 memo from Oregon Health Authority (OHA) and Oregon Department of Human Services (ODHS).
When calling 800-336-6016, please use these options for your prior authorization questions.
Use Option 3 for help with existing fee-for-service (FFS/open card) prior authorization requests. For example:
- Ask about the status of a submitted request.
- Resolve issues with a submitted request.
Use Option 4 for questions about code pairing and FFS/open card prior authorization requirements. For example:
- Ask if OHP covers specific diagnosis and service code pairs.
- Verify whether OHA requires prior authorization for a specific code pairing.
Choosing your options carefully will save you time on the phone and help us give you the support you need.
Billing OHP for refugee health screenings, effective Jan. 1, 2024
OHA has corrected a system issue that caused fee-for-service claims for refugee health screenings to deny when submitted with a primary diagnosis code of Z655.
OHA encourages providers to resubmit claims that denied due to this issue. This only affects fee-for-service claims with a date of service on or after Jan. 1, 2024.
 OHA seeking Rules Advisory Committee (RAC) members for changes to General Rules
The General Rules in Chapter 410, Division 120 affect many providers and people. Please share this information with others who may be affected by, and interested in
providing input about, the proposed rule changes.
OHA is holding a RAC Tuesday, July 9, 2024, from 2 to 4 p.m. At the RAC, members will provide input about the following proposed rule changes. This input will help OHA develop the Notice of Proposed Rulemaking and better understand the fiscal impact of the proposed rule changes.
The RAC will also discuss and make suggestions for future Division 120 rule changes.
Other provider updates
Clarification about reimbursement of licensed dentists for orthodontic care (5/10/2024)
Recent rule revisions
OAR 410-121-0040, 410-121-0147. Amending Pharmacy rules; Exclusions & Limitations, and PA criteria to reference P&T recommendations.
OAR 410-152-0000, 410-152-0005, 410-152-0010, 410-152-0015, 410-152-0020, 410-152-0025, 410-152-0030. Community Violence Prevention Services.
Reminders
Only send confidential claims as follows:
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