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Oregon Health Plan

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.

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 step-by-step guides

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

Training TitleUse SHIFT+ENTER to open the menu (new window).
  
FormatUse SHIFT+ENTER to open the menu (new window).
  
TopicUse SHIFT+ENTER to open the menu (new window).
  
Description
Crossover and Secondary ClaimsWebinarProvider Web Portal (PWP)

May 7, 2013

10:00 a.m. to 10:45 a.m.​

Crossover and Secondary ClaimsWebinarProvider Web Portal (PWP)

June 5, 2013

10:00 a.m. to 10:45 a.m.​

Institutional ClaimsWebinarProvider Web Portal (PWP)

May 9, 2013

10:00 a.m. to 10:45 a.m.​

Professional ClaimsWebinarProvider Web Portal (PWP)

May 9, 2013

9:00 a.m. to 9:45 a.m.​

Dental ClaimsSelf-pacedProvider Web Portal (PWP)
Institutional ClaimsSelf-pacedProvider Web Portal (PWP)
Professional ClaimsSelf-pacedProvider Web Portal (PWP)

Mental Health​

Professional ClaimsSelf-pacedProvider Web Portal (PWP)

General​

Claim AdjustmentsSelf-pacedProvider Web Portal (PWP)

Adjust or re-submit an existing claim​

ADA 2006Self-pacedPaper Billing
UB-04Self-pacedPaper Billing
CMS-1500Self-pacedPaper Billing
DMAP 505Self-pacedPaper Billing
DMAP 1036Self-pacedPaper Billing
UCF 5.1Self-pacedPaper Billing
Pharmacy ClaimsSelf-pacedProvider Web Portal (PWP)
Professional ClaimsHandbookProvider Web Portal (PWP)

General​

Institutional ClaimsHandbookProvider Web Portal (PWP)
Pharmacy ClaimsHandbookProvider Web Portal (PWP)
Dental ClaimsHandbookProvider Web Portal (PWP)
Claim AdjustmentsHandbookProvider Web Portal (PWP)

Adjust or re-submit an existing claim​

Helpful tips

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