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Self-service on the Web
For the first time, DHS will offer a self-service Provider Web Portal, which will give MCOs and supporting staff the ability to:
- Perform online account administration
- Verify and view current recipient eligibility information
- Perform Prioritized List inquiries
- Electronically review and update individual encounters online
- Simplify contractually-required reporting processes
In order to transition providers to this new system, DHS will implement Web portal functionality in phases between December 2008 and March 2009.
Phase 1 — December 2008
The following functions will be available at go-live in early December:
| Online account administration |
Logging onto the Provider Web Portal requires a unique ID and Personal Identification Number (PIN). Two weeks prior to the implementation of the replacement MMIS, DHS will mail your initial logon information. During your first session on the Provider Web Portal, you will then setup your online account information and select a unique username and password.
On the Web Portal, you can assign one or more staff specific roles for accessing claims and eligibility verification screens under the Web portal account for your organization. |
| Eligibility verification |
You will be able to verify and review eligibility on the Web, receiving information such as the client’s benefit plans, third-party coverage, managed care assignments, lock-in information, and service limitations.
Providers will be able to search by client ID or a combination of Social Security Number (SSN) and birth date for specific dates of service. |
Phase 2 — March 2009
The following functions will be available by March 2009:
| Prioritized List inquiries |
You will be able to verify if a specific client is covered for a specific service on the Oregon Health Plan according to diagnosis, service limitations, and real-time eligibility information. The client’s managed care and other important eligibility information will be available, as well as specific Health Services Commission (HSC) guidelines for the diagnosis information entered.
This will give providers comprehensive and accurate service eligibility information for each client when checked on the date of service. |
| Online encounters |
Encounters submitted will be available online for tracking, review and resubmission as needed. |
| Simpler reporting processes |
You will also be able to upload your quarterly financial reporting, data certifications, and complaint logs through the Web portal. |
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