Medical assistance worker guide

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Oregon Health Plan

DMAP Worker Guides

DHS | OHA staff resources to help serve OHP clients

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Guide	Title	Last updated
I	DMAP/Medicaid Overview Responsibilities by division DMAP resources	4/2011
II	Oregon Health Plan History Link to OHP - An historical overview	5/30/08
III	Medical Care Identification Issuing replacement or Temporary IDs and coverage letters Sample Coverage letter and Medical ID	4/2011
IV	Benefit Packages What's covered What's not covered Non-covered conditions Non-covered services Cost-sharing requirements DHS medical assistance program codes Benefit package overview	5/5/10
V	Managed Health Care Systems Types of managed care organizations Enrollment process, disenrollment Effective date Exemptions Third party resources Dual-eligibles Educating clients Who to contact for help	5/30/2008
VI	Other Medical Resources Senior Prescription Drug Assistance Program Family Health Insurance Assistance Program Oregon Medical Insurance Pool Oregon Prescription Drug Plan Oregon Breast and Cervical Cancer Program	4/2011
VII	Payment of Private Health Insurance Premiums Overview Health Insurance Premium Payments program Private Health Insurance program How to refer clients Hearings, forms and other resources Medical Savings Chart Special Conditions Chart add-on list	2/12
VIII	Administrative Examinations and Reports Overview Determining which exam to order Procedure code matrix Guidelines for DMAP 729 series DMAP 729 forms links	5/30/08
IX	Prior Authorizations Examples of medical services and equipment requiring Prior - Authorization Provider contact information	7/26/11
X	Service Denial Codes (withdrawn)	4/2011
XI	Client Rights and Responsibilities Billing of clients Health care complaint process Hearings	6/30/08
XII	Medical Transportation Medical transportation administrative controls Authorizing transports Brokerages Authorization process Special circumstances Client reimbursed travel Place of service codes Volunteer transports Forms	5/30/08
XIII	Processing Claims Overview Questions about billings How a Medicaid claim is processed Claims process flow chart	5/30/08
XIV	Premiums, Copayments and Special Requirements OHP Standard premium overview OHP Plus copayments Home-delivery pharmacy Pharmacy Management Program (Lock-in)	7/26/11

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Page updated: February 28, 2012