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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

  
  
1/21/2022
  
Please submit fee-for-service claim adjustments and appeals electronically; COVID-19 resource and guidance updates; treatment options for Omicron variant; Oregon Resource Allocation Advisory Committee: Call for applicants; Determination deadline for trial-related prior authorization requests; Change log for Jan. 1, 2022 Prioritized List of Health Services; Recent rule revisions (multiple programs)

Archive

  
  
1/7/2022COVID-19 treatment updates; OHA recruitments; recent rule revisions
Interim Guidance for Managing Healthcare Personnel with SARSCoV-2 Infection or Exposure; updated COVID-19 Interim Investigative Guidelines; FAQs, one-pagers about COVID-19 antiviral, long-acting mAb treatment; OHA seeking part-time medical director, Pharmacy and Therapeutics Committee members; Recent rule revisions
12/23/2021COVID-19 treatment, Omicron updates; CAWEM service additions
Provider guide update; new COVID-19 treatment page; Evusheld, Paxlovid, mAb, Omicron resources; Hospitals: RSVP for new ED intervention trainings by Jan. 15, 2022; Rules Advisory Committee for new rule on Interpreter Services reimbursement; Service additions to CAWEM (CWM) benefit package effective Jan. 1, 2022
12/10/2021COVID-19 vaccine booster and third dose updates
Clarification for non-emergent transportation providers about use of private commercial transportation options during the COVID-19 public health emergency; COVID-19 investigative guidelines, home testing, Omicron variant, booster and third dose updates; Funding opportunity for community-based organizations; OHA health IT survey: deadline extension; Jan. 1, 2022 Prioritized List of Health Services;  Oregon's draft OHP 1115 Demonstration application now open for public coomment; Claim reprocessing for DRG hospitals; Recent rule revisions
11/19/2021Update to fee-for-service coverage of COVID-19 home testing
Update to fee-for-service coverage of COVID-19 home testing; Pediatric Pfizer COVID-19 vaccine for ages 5-11; Booster and third dose updates; Updated videos on COVID-19 Resources in American Sign Language; New value-based payment resource library for CCOs, other payers, and providers; OHP 1115 Waiver Renewal policy concepts now published
11/5/2021OHP and CAWEM coverage for flu vaccines, home tests; Pfizer pediatric vaccine resources;
Fee-for-service coverage of COVID-19 home testing effective Nov. 8, 2021; CAWEM coverage of COVID-19 home tests and flu vaccinations during the COVID-19 Public Health Emergency; OHP coverage of children’s COVID-19 and flu immunizations at OHP-enrolled pharmacies; Virtual learning sessions: Pediatric COVID vaccines for clinics; Pediatric Pfizer COVID-19 vaccine resources; boosters and third dose updates; new mAb patient fact sheet; Seeking members for Community Information Exchange Workgroup; October 2021 Behavioral Health Fee Schedule update; Change Log for the 10/1/21 Prioritized List; Recent rule revisions
10/22/2021COVID-19 vaccine requirement, booster dose and monoclonal antibody treatment resource updates
Reminder: Apply now for new COVID-19-related funding opportunities - Applications close Oct. 26, 2021; Virtual learning sessions: Pediatric COVID vaccines for clinics; Free 4-part virtual workshop for health care and frontline workers: "Centering Your Needs: Visioning and Planning for Wellness" begins Oct. 26; American Heart Association and OHSU Hillsboro Medical Center Blood Pressure Symposium: A workshop for healthcare providers; Recent rule revisions
10/8/2021Apply now for new COVID-19-related funding opportunities - Applications close Oct. 26, 2021
“No Wrong Door” for Oregon Health Plan providers billing for covered monoclonal antibody (mAb) services; Oral ivermectin is not approved to treat or prevent COVID-19; Apply now for new COVID-19-related funding opportunities - Applications close Oct. 26, 2021; REALD and COVID-19 reporting requirements - Phase 3 reporting required no later than Jan. 1, 2022; COVID-19 vaccine requirement, booster dose and mAb updates; 2021 Oregon Health IT Survey coming soon; Health Evidence Review Commission seeks members; SUD treatment code and rate changes effective Jan. 1, 2022; fee-for-service prior authorization, Medicaid EHR Incentive Program reminders; MS-DRG implementation delay; recent rule revisions
9/17/2021New COVID-19 provider funding opportunities open for applications Sept. 29
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
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