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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

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
11/6/2020Upcoming telehealth opportunities, Nov. 10 REALD provider webinar
Telehealth listening session for providers; Federal telehealth funding opportunity; Apply for new round of federal Provider Relief Fund payments by November 6, 2020; Implementing REALD for Providers: Updates and FAQs; On-demand diabetes care webinars with no-cost CME; Medicaid EHR Incentive Program is now open; Reminder: Use MSC 189 form to request Electronic Fund Transfer (EFT) account updates; Reminder: Use MSC 189 form to request Electronic Fund Transfer (EFT) account updates
10/23/2020Upcoming training opportunities, new behavioral health resources
Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) Training; No-cost, online tobacco cessation counseling training for providers – free CMEs available; A new screening tool to assess the impact of COVID-19 on children, adolescents, and their families; REALD learning series slides and recordings now available; OHP coverage of COVID-19 testing; Behavioral health program updates - Confidentiality tool kit and CATS RFP; Medicaid program updates - Speech/hearing device and supply replacement, EFT account update process change, Rules Advisory Committee for General Rules program, recent rule revisions
10/9/2020Learn more about October 1, 2020 REALD data collection requirements
Diabetes Control & Dental Care for Patients with Diabetes; Apply for new round of federal Provider Relief Fund payments by November 6, 2020; Replacing health care items in event of natural disasters; Medicaid EHR Incentive Program Year 2020 will open on Sunday, November 1, 2020; Version 38 DRG implementation delayed; OHP 3047 Augmentative Communication Device Support Summary; Recent rule revisions
9/25/2020Requirements for collecting and reporting REALD data effective October 1, 2020
Denture replacement in event of natural disasters; free October 21 webinar about the impact of COVID-19 on substance use and pain management; Other COVID-19 resources; recent rule revisions
9/11/2020Replacement of durable medical equipment, supplies, and prescription drugs in event of natural disasters
Initial therapy for newer antineoplastic drugs will require prior authorization effective October 1, 2020; contact for applied behavior analysis authorization requests; OHP coverage of home blood pressure monitoring services during the COVID-19 emergency; apply for federal Provider Relief Fund applications by September 13, 2020; Health Evidence Review Commission changes effective October 1, 2020; CCO enrollment reminders and updates; Medicaid Program Integrity resources for dental professionals; free training to become a qualified health care interpreter
8/21/2020The Medicaid Advisory Committee is recruiting a physician member
8/14/2020 Prioritized List; OHP coverage of COVID-19 testing; clarification about COVID-19 testing requirements for long-term care facilities; apply for federal Provider Relief Fund applications by August 28, 2020: provider survey on interpretation services in Oregon; apply for 2020-2021 DELTA cohort by August 31, 2020; ICYMI: Postcards claiming to be from OCR
8/7/2020Provider Relief Fund application deadline extended to August 28
Deadline for federal Provider Relief Fund applications extended to August 28, 2020; Interim stability payments (short-term loans) for fee-for-service providers experiencing difficulties associated with COVID-19: updated COVID-19 FAQs and guidance; OHP 3047 Augmentative Communication Device Support Summary
7/24/2020Provider Relief Fund application deadline extended to August 3, 2020
Deadline for federal Provider Relief Fund applications extended to August 3, 2020; COVID-19 updates; recent rule revisions
7/10/2020Updated enrollment form for rendering providers
Updated enrollment form for rendering providers; view your remittance advice online; updated COVID-19 provider guide; apply for federal Provider Relief Fund Medicaid distribution by July 20; other COVID-19 resources for health care providers; Diabetes Prevention Program webinars for CCOs, community-based organizations and clinics
6/26/2020Changes to ACA 1557 do not affect OHP coverage of gender transition services
ACA 1557 and OHP coverage of gender transition services; fee-for-service claim processing updates; COVID-19 provider resources; new Independent and Qualified Agent for Medicaid-covered behavioral health services effective July 1, 2020; recent rule revisions
6/12/2020Financial supports for providers during COVID-19
Apply now for next round of federal Provider Relief Fund General Distribution; bill HHS for COVID-19 testing and treatment of uninsured individuals; OHP coverage of COVID-19 testing;  full-day virtual training on motivational interviewing and patient-centered counseling (no-cost CME available)
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