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Provider Matters

Provider Matters is an email communication that gives Oregon Health Plan providers timely updates, tips and resources related to fee-for-service benefit coverage, criteria, policies and procedures.

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Current issue

New COVID-19 provider funding opportunities open for applications Sept. 29; COVID-19 vaccine, testing, monoclonal antibody updates; New audiology code open for fee-for-service payment; Oregon Health Plan provider appeals processes; Recent rule revisions


9/3/2021COVID-19 OHP NEMT, hospital transfer, third dose coverage; updated resources about vaccination and masking requirements, testing information; Medicaid program updates
Oregon Health Plan coverage for third dose of COVID-19 vaccine; Flexibility for non-emergent medical transportation brokerages to use private commercial transportation options; Mental health residential temporary rate increase for State Fiscal Year 2021 - Reimbursement for T1020 and T2033; Changes to hospital transfer policy and prior authorization requirements for long-term acute care and inpatient rehabilitation services; Vaccine requirements for health care providers and health care staff; Masking requirements; Testing information; Free provider learning opportunities; contract requirements and supplemental payments for the CCO Ground Emergency Medical Transportation Program; Available authorization forms for administrative exam providers; October 1, 2021 Prioritized List of Health Services
8/20/2021Sign up for OHA's Aug. 26 webinar about COVID-19 monoclonal antibody treatment
Updated mask recommendations, FAQs and signage; FDA, CDC and Western States recommend additional vaccine dose for immunocompromised individuals; updates to COVID-19 Testing Page and Recommendations for Clinical Care; Register to join the Oregon Health Authority's webinar on monoclonal antibody treatment for COVID-19 - Thursday, Aug. 26, noon to 1 p.m.; Health Evidence Review Commission membership opportunity for licensed Oregon dentists; Fee-for-service rates for OHA and ODHS private duty nursing services effective July 1, 2021
8/6/2021COVID-19 NEMT, ambulance reimbursement; other COVID-19 updates; SBIRT technical assistance for clinics; recent rule revisions
Fee-for-service reimbursement for non-emergent medical transportation to drive-through COVID-19 vaccination sites; Reminder about ambulance transport and reimbursement policies during the COVID-19 public health emergency; COVID-19 Vaccination or Testing Requirements for Healthcare Providers and Healthcare Staff in Healthcare Settings; Updated Mask Recommendations; Monoclonal antibody treatment for COVID-19; Free SBIRT technical assistance for clinics; Recent rule revisions
7/23/2021COVID-19 resource updates; Provider obligations related to interpreter services; Administrative Exam program updates; recent rule revisions
COVID-19 updates for Oregon Health Plan providers; COVID-19 updates for all health care providers; Reminder: Bill OHA for interpreter services arranged for fee-for-service health care visits; Changes to OHP 729 Administrative Examination Form; Recent rule revisions
7/9/2021COVID-19 reimbursement and resource updates; Medicaid program updates
Temporary fee-for-service rate increase for behavioral health residential providers; Additional payment for in-home COVID-19 vaccine administrations; Coverage of COVID-19 vaccine counseling;  COVID-19 updates for health care settings, testing, long-term care facility vaccination tracking, and more; Medicaid EHR Incentive Program Year 2021 close date extended to October 15, 2021; Recent rule revisions
6/18/2021COVID-19 vaccine updates and provider learning opportunities
COVID-19 vaccine updates for all health care providers (Latina/o/x Vaccination Strategy and Goals; FAQ for people with disabilities; J&J fact sheets); Free webinar with CME: Partnering with patients using self-measurement blood pressure and collaborative communication; On-demand webinars to help practices improve blood pressure control for all patients; Diabetes metrics toolkit webinar: June 22, noon to 1 p.m.; Medicaid program updates (recent rule revisions)
6/4/2021Behavioral health personal care attendant (PCA) reimbursement for trips to COVID-19 vaccination appointments
Behavioral health personal care attendant (PCA) reimbursement for trips to COVID-19 vaccination appointments; Value-based payment (VBP) webinar series for providers (no-cost CME available); State and federal requirements for offering language access services; Reminder: Bill OHA for interpreter services arranged for fee-for-service health care visits
5/21/2021Administrative add-on fee for interpreter services extended for duration of the COVID-19 public health emergency
Administrative add-on fee for interpreter services extended for duration of the COVID-19 public health emergency; Pfizer vaccine, vaccine communications toolkit updates; Emergency Broadband program provides discounted internet service during the pandemic; Value-based payment (VBP) webinar series for providers (no-cost CME available): Next webinar is June 2; Diabetes metrics toolkit webinar: June 22, noon to 1 p.m.; Administrative Examination program updates; recent rule revisions
5/7/2021COVID-19, CAWEM Plus eligibility, NEMT for drive-through vaccination clinics; VBP opportunities; COVID-19 patient template; Medicaid program updates
Clarification about CAWEM Plus (CWX) eligibility during the COVID-19 emergency; Fee-for-service reimbursement for non-emergent medical transportation (NEMT) trips to COVID-19 drive-through vaccination clinics; Updated COVID-19 guidance, talking points and investigative guidelines; Patient letter template to encourage COVID-19 vaccination; J&J vaccine information; VBP webinar series - Next session is May 19; May-June 2021 VBP focus groups; Medicaid EHR Incentive Program is open for Program Year 2021; CAWEM benefit to include emergency dialysis services effective July 1, 2021; Recent rule revisions
4/23/2021COVID-19: CAWEM billing, vaccine updates; Virtual learning series: COVID-19 vaccination for clinics; Medicaid program updates
Status of fee-for-service claims for COVID-19-related services to CAWEM members; new and updated COVID-19 vaccine resources; Virtual learning collaborative: COVID-19 vaccines for clinics; FFS coverage of travel to administrative medical examinations; Recent rule revisions
4/9/2021COVID-19: Provider Guide, vaccine updates; HITOC seeking members; Value-based payment webinar series; Medicaid program updates
Oregon Medicaid COVID-19 Provider Guide updates, including coverage of home care through the Acute Hospital Care at Home waiver, COVID-19 lab testing code (U0005) effective 1/1/2021, effective dates and minimum eligible ages for COVID-19 vaccines, and resources for COVID-19 vaccination sites; COVID-19 vaccine updates and resources for all health care providers, including PREP Act Authorization information and resources; HITOC member applications due April 16, 2021; Value-based payment series (no-cost CME available); Medicaid EHR Incentive Program Year 2021 opens Saturday May 1, 2021; Clarification about opioid tapering; Recent rule revisions
3/26/2021COVID-19 vaccine reimbursement, resource updates; Telehealth opportunities; DRG implementation; Recent rule revisions
OHP vaccine administration reimbursement for community health centers; Oregon Medicaid COVID-19 Provider Guide updates; new and updated COVID-19 resources for vaccination sites, employers, hospitals, ASC and ESRD facilities; Oregon Broadband Office Request for Information; Northwest Regional Telehealth Resource Center Annual Conference; MS-DRG, LTC-DRG and Oregon Unique DRG updates effective Oct. 1, 2020; Recent rule revisions
3/12/2021Janssen Vaccine Updates; OHP Newborns and CCOs; Value-Based Payment Webinars; Medicaid Program Updates
EUA Fact Sheets for Johnson & Johnson / Janssen COVID-19 Vaccine; Vaccine communication resources; Ensuring continuity of care for OHP newborns; Spring 2021 Value-based Payment webinars; post-payment review for outpatient therapy claims; prepayment review for administrative exam and billing services; 2021 Visual Services collaboratives; Medicaid EHR Incentive Program Year 2020 attestations due March 31, 2021
2/26/2021CAWEM and COVID-19; Vaccine Resource Updates; Patient-centered Counseling Trainings; Reproductive Health Equity Act; Prioritized List change log; recent rule revisions
Reminder about COVID-19 vaccine, testing and treatment coverage for CAWEM members; Patient-centered Counseling: Virtual Trainings for Medicaid providers (no-cost CME available); Reproductive Health Equity Act; Change log for the Feb. 1, 2021 Prioritized List of Health Services; Recent rule revisions
2/12/2021COVID-19 Vaccine and REALD Updates; Feb. 1 Prioritized List; Dental and Hospital Program Updates; Recent Rule Revisions
Help Oregon complete Phase 1a of the COVID-19 Vaccine Sequencing Plan; FFS COVID-19 vaccine administrations through point of sale; "No Wrong Door" policy for OHP coverage of COVID-19 vaccine administrations; Eliminating barriers to care for people with disabilities; vaccine, clinical guidance and REALD information for all health care providers; Feb. 1, 2021 changes to the Prioritized List of Health Services; Jan. 1, 2021 Covered and Non-Covered Dental Codes; Version 38 DRG Implementation; recent rule revisions
1/22/2021COVID-19 NEMT, vaccine and webinar updates; free veterans health care webinar
Jan. 26 Community Partner webinar; Current non-emergent medical transportation (NEMT) requirements for expired licenses and vehicle registrations during COVID-19; OHP coverage of NEMT to alternate sites for COVID-19 vaccine administration; COVID-19 vaccine sequencing plan, health talking points, provider webinars and vaccine office hours; Military Culture Awareness and Suicide Prevention Training for medical and behavioral health care providers; OregONEligibility (ONE) system upgrade nears completion; Dental program updates effective Jan. 1, 2021; How to verify OHP eligibility and enrollment without the Oregon Health ID card
1/8/2021Add-on fee for interpreter services, billing OHP for COVID-19 vaccine administration
Add-on fee for interpreter services now open for fee-for-service payment; Reminder about temporary expansion of CAWEM-only (CWM) coverage for COVID-19-related services; Oregon Medicaid COVID-19 provider guide updates; Supporting dental visits for children during COVID-19 and beyond; REALD, provider webinar updates; Jan. 1 Prioritized List change log; Recent rule revisions
12/18/2020New COVID-19 testing, vaccine and REALD resources
COVID-19 and NEMT stretcher van transports; updated Oregon Medicaid COVID-19 Provider Guide; COVID-19 Testing, Vaccine and REALD resources; Collaboration with Comagine Health for behavioral health requests and referrals; 2021 Visual Services collaboratives; Recent rule revisions; Medicaid EHR Incentive Program and EFT reminders; Proposed changes to HIPAA Privacy Rule
12/4/2020New and updated COVID-19 resources; January 1, 2021 Prioritized List
Novel Coronavirus Coding; Best Practices for Hospitals and Long-Term Care Facilities for COVID-19 related New/Readmissions and Discontinuing ​Transmission-Based Precautions; COVID-19 Vaccines web page; Telehealth and REALD recordings; ​January 1, 2021 Prioritized List of Health Services; Medicaid EHR Incentive Program and EFT reminders
11/20/2020COVID-19 resource updates, Oct. 1 fee-for-service hospice rates
Medicare Monoclonal Antibody COVID-19 Infusion Program Instruction; Updated Clinical Care, and Healthcare Infection Prevention and Control Guidance for COVID-19; Slides and recording from OHA's Nov. 10, 2020 REALD provider implementation webinar; October 1, 2020 fee-for-service hospice rates; MEHRI and EFT reminders; Recent rule revisions
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