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).
Oregon Administrative Rule 410-148-0100 states OHP is the primary payer, before WIC, for all formula covered by OHP to treat children enrolled in both programs. See OHA’s March 2024 memo and the final posted rule for more details.
If you have patients with both OHP and WIC coverage:
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Ask for prior authorization of the formula. For CCO members, follow the CCO's process. For fee-for-service (open card) members, follow OHA's process.
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If patients need WIC support or medical formula while waiting for approval, connect with WIC!
WIC can provide a supplemental amount of medical formula on the WIC formulary.
To request medical formula for OHP patients with WIC:
Please note: As a supplemental food program, WIC may not be able to provide the full amount the patient needs.
Learn more about the ways WIC can help:
Questions? Need help connecting with your local WIC program?
Please email Ellen Hill, MPH, RDN, WIC Nutrition Consultant at ellen.r.hill@oha.oregon.gov.
WIC celebrates 50 years of supporting family and child health with access to healthy food, breastfeeding and lactation support, health screenings and referrals. Thank you for your referrals and partnership with WIC. This ensures families get the services and long-term nutritional support they deserve.
OHA’s Health Care Market Oversight program seeks members for two community review boards.
OHA would like to hear from people who have received care at OHSU or Legacy, health care providers, health care experts, and consumer advocates. Applications are due
Last month, we hosted an office hours session for individuals interested in providing health-related social needs (HRSN) housing services. We had a great conversation and answered many housing questions during the session.
Our final session of the year will be a housing-specific billing and payment training. We will cover:
- Fee schedule and billing scenarios
- AYIN reimbursement process
- Resource overview
Spanish interpretation and closed caption will be available. If you need support or accommodations to participate, please email 1115.Waiver.Renewal@odhsoha.oregon.gov.
Becoming an HRSN service provider:
To begin the process of enrolling as an HRSN service provider, complete the Provider Enrollment application:
Where to find "Providers > Enrollment" at https://www.or-medicaid.gov
Once you've completed the application, please email the Provider Enrollment Team at Provider.Enrollment@oha.oregon.gov.
- In the email, let them know that you submitted an application to become an HRSN service provider.
- This will ensure that your application can be processed sooner.
If you have additional questions about enrolling as an HRSN Service Provider:
Questions?
If you have questions related to HRSN services:
Billing for members with OHP Bridge benefits
As for members with other OHP benefits, please verify CCO or fee-for-service (open card) coverage, then bill accordingly.
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For CCO members, bill the member’s CCO. Contact the member's CCO for their specific billing instructions.
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For fee-for-service (open card) members, bill OHA. (Some systems show this coverage as "DMAP" coverage, though this term should not be used with patients.) OHA's payer ID is ORDHS. Refer to the OHP Billing page for billing instructions and mailing addresses.
All members with OHP Bridge benefits have the "BRG" benefit package. This includes:
Questions?
Provider resources
Ambulatory Payment Classification Weight Update, Calendar Year 2025
Frequently asked questions about prior authorization for Behavior Rehabilitation Services
CCO Dental Directed Payment webinar slides and web page (12/3/2024)
Pending Jan. 1, 2025 Prioritized List of Health Services (12/1/2024)
Recent rule revisions
OAR 410-121-0160. Amending Rules to Update Dispensing Fees Based on Recommendations from Cost to Dispense Survey.
OAR 410-141-3500, 410-141-3860, 410-141-3865, 410-141-3870. Rule Updates to Further Clarify Requirements of CCOs to Improve Care Coordination Activities.
Multiple Dental (Division 123) Rules. Reorganization of Rules Intended to Provide Clarity and Readability.
Multiple General Rules (Division 120) and Medical Program (Division 200) Rules: Young Adults with Special Health Care Needs.
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