Tools for providers

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Health care providers – Get the tools you need to serve people on OHP (Medicaid) and successfully do business with DMAP.

Want to become an OHP provider?

Go to DMAP's Provider Enrollment page.

Billing information

• Common FFS billing errors 
• Billing tips - How to submit claims to DMAP
• Free training for Web - dental / institutional / professional / pharmacy / crossover and secondary claims
• How to read a Remittance Advice
• Program-specific rules and supplemental information
• What are DMAP's maximum allowable fee-for-service rates?

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Client eligibility and enrollment

• Automated Voice Response quick reference  - 866-692-3864
• Provider Web Portal quick reference 
• General Rules guidelines - Medical Care IDs, copayment, benefit package information
• Eligibility verification tutorial

Copayments

• Frequently asked questions
• Eligibility verification options and copayment information
• How to verify copayments 

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Covered benefits

• Benefit packages: Frequently asked questions
• Tobacco Cessation Services  2011 Survey - Summary of services provided by OHP medical and dental plans.
• Oregon Health Plan benefit packages 
• OHP Dental Benefits - In English  and Spanish 
• Prioritized List of Health Services
• Provider guidelines

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Direct Deposit

To receive your payments from DMAP using Electronic Funds Transfer (EFT, or direct deposit), complete this form.

Electronic Data Interchange (EDI)

• Administrative simplification
• How to get started
• How to become an EDI submitter
• HIPAA X12 5010 transition
• Resources and EDI standards - How to set up your EDI transactions
• Registration forms

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Forms

Make sure to refer to your provider guidelines for the forms required for your program.

• Forms for applicants
• Forms for clients
• Forms for managed care plans
• Forms for outreach sites
• Forms for providers
• Electronic Data Interchange forms
• Other DHS/OHA forms

Fraud and abuse

• Employee Education about False Claims Recoveries 
• DHS Fraud Reporting and Investigations
• DHS Fraud Referral Database
• General Rules provider guidelines

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Frequently Asked Questions (FAQs)

• Benefits
• Complaints and appeals
• Copayments
• Eligibility
• HIPAA X12 5010 transition
• Medicaid EHR Incentive Program
• Medical payment recovery
• National Drug Code reporting
• National Provider Identifier
• Pharmacy pricing and reimbursement
• Premiums
• Provider Web Portal
• Service delivery

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National Provider Identifier

• Frequently Asked Questions
• NPI look-up – NPIs are required on all prescriptions
• To update your NPI and taxonomy information with DMAP, contact Provider Enrollment (800-422-5047).

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New providers

• How to enroll as an OHP provider
• Keys to Success - Partnering with DMAP 
• Learn how to verify OHP eligibility
• Sign up for direct deposit  and look into electronic billing
• Sign up for OHP updates for rules, guidelines, resources and more
• What provider materials do you need?

Outreach sites

Providers of direct medical services may contract with DMAP to help enroll patients in Oregon's state health coverage programs such as Healthy Kids and OHP Plus. Patients who receive an application and get help filling out the application are more likely to get coverage. Please find more information about this program on the Healthy Kids Provider Outreach Sites page.

PERM (Payment Error Rate Measurement)

PERM is a federally mandated review of Medicaid and CHIP claim payments. Each state is reviewed once every three years. Oregon's next PERM cycle begins September 2010 for FFY 2011 (Oct. 1, 2010 to Sept. 30, 2011).

• Learn more about PERM
• Frequently Asked Questions
• CMS video – Responding to Medical Documentation Requests

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Prior authorizations

For authorization of services covered by OHP medical and dental plans, contact the plan.

• Contact information for fee-for-service requests  
• EDMS Coversheet – Use for each PA request sent to DMAP  
• Program-specific instructions
• Request form for prescriptions and oral nutritional supplements 
• Universal request form for all other services  

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Prioritized list

• Current Prioritized List
• Past Prioritized Lists
• Pending changes to the Prioritized List
• Recent changes to the Prioritized List
• Web portal HSC List Inquiry  

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Provider guidelines

• Current rules (OARs) and guidelines
• Notices of rulemaking, proposed revisions and hearings
• Provider guidelines archive
• Temporary rules - (certificates of filing)

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Provider Web Portal

• Sign in at https://www.or-medicaid.gov
• Contact team.provider-access@state.or.us (800-336-6016) for PINs or password resets
• Free training for Web basics, eligibility, HSC List, prior authorization, dental / institutional / professional / pharmacy / crossover and secondary claims
• Handbooks and tutorials for Web billing
• Quick references for account setup, eligibility, HSC list inquiry

Remittance Advice

• Common FFS billing errors 
• How to read a Remittance Advice 
• What to do after you receive your RA

Third-party liability (TPL)

• Learn how to bill for clients with TPL  using the Provider Web Portal
• Phone numbers for the TPL carriers currently on file with DMAP 
• Report TPL to DHS using the DHS 415H 
• See your specific provider guidelines and DMAP's General Rules to learn more.
• What happens when TPL isn't billed first?

Training

• 2012 Web portal classroom training 
• Free Web-based training
• Medicaid EHR Incentive Program
• PERM

When you need help

• About DMAP Provider Services - Learn what PSU can and cannot do
• DMAP Provider Contacts  - Phone numbers and other contact information for fee-for-service providers

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