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Everything you need to know about the new MMIS
Look here for a collection of the information providers need to know to conduct business with the new Medicaid Management Information System (MMIS) that went live Dec. 9.
Need help? If you need a PIN or password reset for the Web portal or Automated Voice Reponse, contact DMAP at team.provider-access@state.or.us. For other questions and current contact information, click here.
Provider Alerts! Find the latest MMIS updates at this link (and on your What's New link in the Provider Web Portal).
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WHAT YOU NEED TO KNOW
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FIND IT ON THE WEB
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---Benefit plan codes
Web portal and AVR indicate DHS medical eligibility by reading 3-digit benefit plan codes. The codes that indicate DHS medical eligibility are:
- BMD (OHP with Limited Drug)
- BMH (OHP Plus)
- BMM (Qualified Medicare Beneficiary and OHP with Limited Drug)
- CWM (Citizen-Alien Emergency Waived Medical)
- CWX (CAWEM Plus – OHP Plus benefits for pregnant CAWEM-eligible women in Multnomah and Deschutes counties)
- KIT (OHP Standard)
- MED (Qualified Medicare Beneficiary)
Disregard all other codes. They are for internal use only.
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Eligibility verification information
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---Copayments
Call the Automated Voice Response to verify if a client has a copayment. If client is responsible for a copayment, you will hear a message that begins, "Some clients will be responsible for copayments..." If the client does not have a copayment, you will not hear this message.
The Provider Web Portal does not provide client-specific copayment information at this time.
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Eligibility verification information
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---Coverage letters delayed
Medical Care IDs have now been mailed to all clients. Their coverage letters have not yet been sent. This means that clients may not know what benefit plan they are in, if they have copayment requirements or if they are enrolled in a managed care plan.
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WHAT YOU NEED TO KNOW
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FIND IT ON THE WEB
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---Automated Voice Response
AVR phone number: 866-692-3864
Lost your PIN letter? Need your PIN reset?
Call Provider Services at 800-336-6016. Provider Services can reset your PIN for the AVR over the phone during regular business hours.
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Eligibility verification information
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---Provider Web Portal
The Provider Web Portal is at https://www.or-medicaid.gov. All Web portal functions (including eligibility, claims, HSC list inquiry, prior authorization requests, demographic updates, and drug search) are now available. To get access to Web portal functions, you need to contact the Web portal administrator for your office, who will update your clerk roles. More information about updating clerk roles is available at this link.
Requesting a new PIN
To request a new PIN for the Provider Web Portal, e-mail your provider name and provider (Medicaid) number to Team.Provider-ACCESS@state.or.us or call 800-336-6016. Due to privacy regulations, PINs must be reissued through the mail. You will receive a new PIN in three to four days.
Resetting passwords
Once your Provider Web Portal account has been set up, Provider Services can reset your password over the phone during regular business hours. Call 800-336-6016. Press 5 for resets.
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Provider Web Portal: https://www.or-medicaid.gov
Provider Web Portal resources:
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WHAT YOU NEED TO KNOW
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FIND IT ON THE WEB
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---Prior Authorizations
Centralized PAs (authorized by Acumentra, ICM or DMAP)
If you send PA requests to the following fax numbers, you must include the new EDMS coversheet (DHS 3970) with the "Prior Authorization" box clearly marked for each PA request you submit. Otherwise, your request will be delayed.
- Routine Requests: 503-378-5814
- Urgent/Immediate Requests: 503-378-3435
Use the new PA request form (DHS 3971). For all requests sent to the central fax numbers listed above:
- Use the new EDMS coversheet (DHS 3970) for all PA requests. Make sure to enter your provider number and the client's ID number on this sheet.
- Do not use one coversheet for multiple PA requests. Each PA request (and any supporting document sent at a later date) must have its own coversheet.
Prescriber PAs:
Use the new Pharmacy and EPIV PA request form (PDF) (DMAP 3978). Fax PA requests for drugs and oral nutritional supplements to the Oregon Pharmacy Call Center. Misrouted PA requests will be delayed.
- Fax: 888-346-0178
- Phone assistance: 888-202-2126
Existing PAs in the new MMIS
Existing PAs will stay valid until they reach their current end date in the new MMIS.
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The supplemental information for each program contains:
- Program-specific PA instructions, sample forms and links to forms
- Detailed instructions on how to complete the new PA forms, if required
New PA forms:
Contacts for PA requests:
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WHAT YOU NEED TO KNOW
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FIND IT ON THE WEB
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---Billing changes
Oral nutritional supplements – Bill on CMS-1500 (not the UCF 5.1) using a 5-digit HCPCS.
Dental procedures - Include the tooth, surface or quadrant number for any procedure code that directly involves a tooth, surface or range of teeth.
Services requiring prior authorization (PA) – PA numbers are now 10 digits. When referencing a PA number authorized before December 2008, add a leading zero. For example, an "old" PA number of "081234567" will become "0081234567."
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DMAP Provider Guidelines -(administrative rules and supplemental information)
- EPIV
- Dental Services
- Pharmaceutical Services
Paper claim billing tips and tutorials
Find out the most common fee-for-service (FFS) billing errors in the new MMIS and how to resolve them.
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Electronic Data Interchanged (EDI)
Make sure your claims transactions comply with the updated specifications, and that you complete business-to-business (B2B) testing to ensure claims process appropriately.
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EDI Companion Guides
EDI Registration and Testing
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---National Provider Identifier
Claims processing
The prescriber field for pharmacy claims will require a prescriber National Provider Identifier (NPI). Pharmacy NPIs and default provider numbers, such as 999999, will no longer be accepted. See exceptions in OAR 401-121-150.
- Prescribers - Include your NPI on all your prescriptions.
- Pharmacies - Look up NPIs
835 remittance advice delays
The new MMIS requires that each DHS provider number be associated with only one NPI.
- When a DHS provider number has more than one associated NPI, Provider Enrollment must add new DHS provider numbers and service locations for the additional NPIs.
- If the existing provider received an 835, the records for the existing provider and all new service locations must indicate who should receive the 835; otherwise, the 835 will not be sent to the provider.
- If you have not received an 835, you may need to contact DHS to get your records updated to show who should receive the 835.
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Click here for more information about NPI requirements, including how to apply for an NPI.
Click here for pharmacy provider guidelines (administrative rules and supplemental information).
For more information about the 835, see EDI Questions and Answers (PDF).
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WHAT YOU NEED TO KNOW
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FIND IT ON THE WEB
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---Pharmacy Point of Sale (POS)
Make sure your value-added network (VAN, or "switch") meets the specifications outlined in the new POS Payer Sheet. Major billing changes include:
- Patient information comes from the Insurance Segment, not the Patient Segment.
- Only Prescriber National Provider Identifiers (NPI) are accepted in the NCPDP field 411-DB. Click here to look up NPIs online.
- Submission Clarification Codes (NCPDP field 420-DK) can be used to override some common ProDUR edits (NCPDP Error - 88), including ER, PG Severity Level 1, ID and TD.
- Compound Claims require 02 in NCPDP field 406-D6, 00 in 436-E1 and 0 or 00000000000 in field 407-D7. To accept partial payment and dispense a non-covered product as part of the compound, enter 08 in field 420-DK.
- To receive the long term care dispensing fee, enter 04 for the patient location code in NCPDP field 307-C7.
- To receive the 340b dispensing fee, enter 09 for the basis of cost code in NCPDP field 423-DN.
- Immunization Fees are linked to the dispensing of specific NDCs; no additional data entry is required.
- The client's date of birth (DOB) is required for in field 304-C4 of the Patient Segment.
- The client's first name and last name are mandatory and must be entered in fields 312-CC and 313-CD of the Insurance Segment.
- The new time limit for reversing claims through point-of-sale is the days supply plus 30 days. After the time limit has expired, adjustments require an Individual Adjustment Request form (DMAP 1036).
Direct POS transactions to the BIN number for EDS, the new pharmacy benefit manager (PBM).
- ANSI BIN #: 014203
- Processor Control #: ORDHSFFS
Pharmacies will no longer need a group name. Claims sent to previous BIN will be denied.
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Pharmacy POS Payer Sheet
Pharmacy provider guidelines - Includes links to POS and ProDUR information.
DMAP 1036 Instructions (for paper adjustments to POS claims)
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WHAT YOU NEED TO KNOW
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FIND IT ON THE WEB
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---Remittance Advices (RAs)
Remittance Advices (RAs) are now much more comprehensive, which may cause a delay in production.
Edits and EOBs
The new MMIS has many more edits, some of them informational that require no action on your part. Some edits are related to how your provider records are set up in the new MMIS, which may require correction by Provider Enrollment and/or EDI Support Services.
835 Remittance Advice delays
If you have not received an 835 in the new system, you may need to contact DHS to get your records updated to get your records updated to show who should receive the 835.
Don't want to wait for your RA or check?
Avoid future delays by signing up for Electronic Funds Transfer (EFT) to have your payments electronically deposited.
If you are registered as an Electronic Data Interchange (EDI) trading partner, you can sign up to receive your Remittance Advice electronically.
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Click here for more information about the new RAs, including sample RAs and explanation of benefit (EOB) codes.
Click here for the Top Billing Errors and Resolutions (PDF).
Click here for RA and EDI Questions and Answers (PDF), which includes new information about EOBs related to MMIS conversion.
Click here for MMIS temporary protocols – EOBs 0156 and 9013
Click here to download the EFT/Direct Deposit Authorization form.
Current trading partners - Click here to sign up for the electronic RA. Check the box for "835 Health Care Claim Payment/Advice (RA)."
New to EDI? This page walks you through the steps to becoming an EDI trading partner.
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---Transitional Payments
If you do not receive an expected payment through the regular financial cycle, you may qualify for a Transitional Payment.
- Complete the new Transitional Payment form, save it to your computer, then send it as an e-mail attachment to DMAP's Transitional Payment Coordinator.
- You may need to adjust the security settings for your Internet browser.
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Transitional/Special Payment Request form (Word or PDF)
These instructions (Word) tell you how to adjust your Internet Explorer browser settings to enable macros for Microsoft Word documents you open through your Internet browser.
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WHAT YOU NEED TO KNOW
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FIND IT ON THE WEB
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---Provider training for MMIS
DHS is scheduling additional classes about the Provider Web Portal for February and March.
- DHS will hold classes in person and via Netlink (live trainings accessed at your computer).
- Check the course calendars for the latest dates as DHS adds them to the DHS Learning Center.
Web-based eCourse
You can also take the Web-based eCourse anytime from your own computer. You will need Internet Explorer 6 and the Adobe Flash Player to view the eCourse.
Registering for training
To register for any of the MMIS trainings, including the eCourse you need to sign up with the DHS Learning Center at https://dhslearn.hr.state.or.us.
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Click here for detailed MMIS course descriptions
MMIS Eligibility Web Portal Provider Training
- Classroom training - View the course calendar for dates and locations.
- Netlink - View the course calendar for dates and locations.
- Click here to sign into the DHS Learning Center, read the course description, and register for this course. Search by course number C01033 (classroom) or C01036 (Netlink).
MMIS Provider eCourse
- Sign into the DHS Learning Center, click "Courses and Registration," then "Find a Course and Register," then search for course number C00818.
- Click on the link that reads, "MMIS provider eCourse," scroll down, and click the "Take Course" button, then click "Index SCO Title."
- If the course does not run, make sure you are using Internet Explorer 6 and the Adobe Flash Player. Also try these eCourse quick fixes (PDF).
DHS Learning Center
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---Provider announcements
The "What's New" link that you can view from the Provider Web Portal will include important updates to this page, the MMIS-related provider announcements from DMAP, EDI system status updates, and other information related to MMIS implementation. Please check it frequently!
DMAP encourages you visit the pages listed at right or, even better, eSubscribe to get e-mail updates whenever DMAP makes updates to these pages (adds new announcements or resources).
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OHP provider announcements
Pharmacy program announcements
"MMIS – What's New" RSS feed
EDI System Alerts
DMAP Provider Guidelines
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Who do I call?
Refer to the Provider contacts list (PDF) for all current contact information for DMAP. Quick references are listed below.
Eligibility verification
AVR: 866-692-3864
Provider Web Portal:
https://www.or-medicaid.gov
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Third-party resources
Managed care enrollment
Benefit package
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| Provider Enrollment 800-422-5047 or provider.enrollment@state.or.us
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Address/phone number changes
Changes in billing information, i.e. NPI or taxonomy codes
Adding new providers for Medicaid billing
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Provider Services
800-336-6016 or
dmap.providerservices@state.or.us
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- Claims
- Billing issues
- Appeals
- PIN and password resets
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EDI Support Services
888-690-9888 or
dhs.edisupport@state.or.us
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- Electronic data interchange (claims) submissions and status
- Trading partner registration and testing
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| Oregon Pharmacy Call Center 888-202-2126 (telephone)
800-346-0178 (fax)
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- Fee-for-service prior authorization (PA) requests for drugs and oral nutritional supplements
- Pharmacy technical questions
- Pharmacy coordination of benefits
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Provider Matters
These are past issues (in PDF format). For the most current issue, go to the OHP home page (look under "MMIS updates").
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