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Medical Assistance (General Rules) Program

Medical Assistance (General Rules) Program

Oregon Administrative Rules and supplemental information administered by the Health Systems Division.

Recent rule filings

You can sort or filter by document type or effective date. You can also view Medical Assistance (General Rules) Program rules as filed with the Secretary of State (please note that rules filed by the first of the month will not be posted on the Secretary of State website until the middle of the filing month).

  
  
File Description
  
Nprm-120-0006-06172016Notice of Proposed Rulemaking
410-120-0006
Align with Department of Human Services OAR Chapter 461 Rules
There is no hearing for this rule.
Last opportunity to comment: June 17, 2016, by 5 p.m.
Send comments to dmap.rules@state.or.us.
6/17/2016
Nprm-120-1280-04212016Notice of Proposed Rulemaking
410-120-1280
Update DMAP 3165 Form
There is no rulemaking hearing for this form change. No rule language changed.
Last opportunity for public comment: April 21, 2016 by 5 p.m.
Send comments to: dmap.rules@state.or.us.
4/21/2016
120-1340-03012016Permanent Rule Filing
410-120-1340
Annual Updates; Relative Value Unit (RVU) Weight; Clinical Lab, ASC
3/1/2016
Nprm-120-1340-02192016Notice of Proposed Rulemaking
410-120-1340
Annual Updates; Relative Value Unit (RVU) Weight; Clinical Lab, ASC
This is rulemaking, and there is no hearing.
Last Opportunity for Public Comment: February 19, 2016
Send comments to dmap.rules@state.or.us
2/19/2016
120-0006-01012016Permanent Rule Filing
410-120-0006
Align with Department of Human Services OAR Chapter 461 Rules
1/1/2016
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Administrative rulebooks

  
  
120rb0301163/1/2016
120rb0101161/1/2016
120rb10011510/1/2015
120rb0701157/1/2015
120rb0304153/4/2015
1 - 5Next
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Supplemental information and guidelines

Provider guides

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Prior Authorization Handbook
Provider Enrollment Handbook
General Rules Provider Guide, 9-26-2014
Paving the Road to Good Health
EPSDT Coverage Guide
1 - 5Next

Fraud and abuse authorities

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Answer
You can also report fraud online. For more information, see the DHS frequently asked questions about reporting fraud.
 
Medicaid Fraud Control Unit (MFCU)
1515 SW 5th Avenue, Suite 410, Portland, OR 97201
Phone (971) 673-1880, or fax (971) 673-1890
Provider Audit Unit (PAU)
3406 Cherry Ave NE, Salem, OR 97303
Phone (888) 372-8301, or fax (503) 378-2577
Fraud Investigations Unit (FIU)
P.O. Box 14150, Salem, OR 97309-5027
Phone (888) 372-8301, or fax (503) 373-1525


Other resources

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Oregon Medicaid Third Party Liability Requirements
Provider Tips - Billing Clients
Provider Tips - OHP and QMBs
Oregon primary care providers and procedure codes
Eligibility Group categories
Questions and answers about client co-payments
2014 federal primary care codes and rates
Sample Oregon Health ID (formerly Medical Care ID)
2013 federal primary care codes and rates
Provider Discrimination Review Process

Forms

  
  
OHP 1074OHP 1074 - Prior Authorization for Out-of-State Services
OHP 3035OHP 3035 - Provider Information Update
OHP 3113OHP 3113 - Provider Enrollment Short Form
OHP 3162OHP 3162 – AVR Quick Reference Guide
OHP 3161DMAP 3161 - PWP eligibility verification screen
MSC 3970MSC 3970 - EDMS Cover Sheet
OHP 3085OHP 3085 - Request for Claim or Payment Authorization Review
OHP Provider Enrollment FormsOHP Provider Enrollment Forms
OHP 3165OHP 3165 - OHP Client Agreement to Pay for Health Services
OHP 3165OHP 3165 - OHP Client Agreement to Pay for Health Services
OHP 3165OHP 3165 - OHP Client Agreement to Pay for Health Services
OHP 3165OHP 3165 - OHP Client Agreement to Pay for Health Services

Who to call for help

Provider Services 800-336-6016 or email us
Address and telephone contacts

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