How to submit claims to DMAP

Learn how to bill DMAP for services delivered to OHP clients on a fee-for-service basis. Also refer to the provider guidelines for your program and DMAP's General Rules.

• Billing basics
• Handbooks and tutorials
• Helpful tips

If you have questions about which format to use, or have other billing questions not answered by these documents, you can call DMAP Provider Services at 800-336-6016, or e-mail them at dmap.providerservices@state.or.us.

Billing basics

For billing purposes, DMAP uses Current Procedural Terminology (CPT), Level II National Codes (HCPCS) and Current Dental Terminology (CDT) procedure codes. DMAP does not cover all valid codes, and DMAP may not allow covered codes in all settings.

DMAP expects providers to bill their usual and customary charges unless otherwise specified in the rules for a specific provider program; for example, DMAP pays for some services at acquisition costs only.

• Maintain documentation of all services provided that support the fee or rate you bill; the date of service; the individual who provided the service; and any other documentation required by rule, provider guidelines or contract.
• Use all applicable administrative rules (OARs) to determine if there are any coverage criteria, limitations, restrictions, exclusions or client benefit limitations related to a specific procedure code. DMAP bases all reimbursement on client eligibility and DMAP covered services.
• Bill other resources first. In most cases, Medicaid is the payer of last resort. For DMAP clients with third-party resources (other insurance, including Medicare), DMAP pays the DMAP-allowed rate or fee, less the TPR payment but not to exceed DMAP's maximum allowable rate or fee.
• Do not deduct a DMAP client copayment from the fee submitted on the claim. DMAP will deduct the amount of the copayment from the amount paid to the provider.

Handbooks and tutorials

Learn about DMAP claim processing, how to bill DMAP on paper, and how to bill using the Provider Web Portal.

Back to top

Helpful tips

• Common FFS billing errors - updated 8/5/10 (PDF): This document shows resolutions to various Explanation of Benefit (EOB) codes that appear on your fee-for-service Remittance Advice. 
• UB-04 Billing Tips for Nursing Facilities - updated 7/21/10 (PDF): This document contains helpful reminders for how to complete the UB-04 paper claim form. 
• DMAP 1036 Reminders for Nursing Facilities - updated 7/21/10 (PDF) - This document contains helpful reminders for when to use the DMAP 1036 form and how to complete the form.

National Drug Code (NDC) Billing Tips (PDF) - updated March 2012 - This document explains how to enter NDC information on medical and institutional claims for physician-administered drugs.

• For more detailed information, review DMAP's NDC billing Webinar.
• Also see DMAP's Frequently Asked Questions about National Drug Code reporting.

Back to top