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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

Monthly partner webinar series: Preparing for the COVID-19 Public Health Emergency (PHE) to end; OHA seeks members for Rules Advisory Committee to discuss changes to Medicaid rule about clinical trial coverage changes; Jan. 1, 2022 CWM coverage of emergency cancer and behavioral health crisis treatment to be implemented this September; Recent rule revisions; Provider resource updates


7/29/2022COVID-19 home test, vaccine updates; Provider billing and member reimbursement for retroactive OHP Supplemental benefits
Fee-for-service reimbursement of COVID-19 self-collected, self-administered test kits provided by non-pharmacy providers; Novavax fact sheets; Vaccine Learning Series: Join OHA's Aug. 18 webinar; Provider billing and member reimbursement for retroactive OHP Supplemental benefits; Reminder: Hospital inpatient reporting process; Provider resource updates
7/15/2022Webinar about Data and Strategies for COVID-19 Pediatric Vaccine Catch-up. July 21, 9 to 10 a.m.
COVID-19 Vaccine Learning Series - Recordings and live webinars; Core Resource on Alcohol: 14 guides to address alcohol use, from screening to recovery (with free CME/CE); Military Culture Awareness and Suicide Prevention Training: Free two-day training for Oregon health care providers; Pharmacy point of sale dose optimization edit for select fee-for-service prescriptions effective July 11, 2022; Limited drug coverage for Citizenship Waived Medical (CWM) benefit
7/1/2022COVID-19 vaccines for 6-month through 5-year old age groups - Resources and webinars
Model immunization protocols (updated 6/29/2022); resource updates; July webinars; Starting today, more people may be eligible for OHP Plus benefits; Use the MMIS Provider Portal to submit fee-for-service prior authorization requests online; Fee-for-service nursing facility room and board rates effective July 1, 2022; Recent rule revisions
6/17/2022COVID-19 Vaccine Learning Series: Preparing for 6-month through 5-year old vaccine rollout
COVID-19 Vaccine Learning Series; Doing Well, Being Well Series: Yoga as Self Care; Healthier Oregon: More people may be eligible for OHP Plus benefits starting July 1, 2022; Fee-for-service rate increase for newborn bloodspot screening kits used by community birth providers and freestanding birth centers, effective 9/1/2021; Updated OHP Pregnancy Notification form; Supported browsers for the MMIS Provider Web Portal; Recent rule revisions
6/3/2022Provider Collaborative: 2022 Citizenship Waived Medical (CWM) program changes
Updated Novel Coronavirus Coding guide; Training opportunities - CWM Provider Collaborative and PERM Provider Overview webinars; PANDA/PANS coverage guidance approved May 19, 2022; updated Institutional Billing Handbook
5/20/2022Updated COVID-19 Provider Guide, therapeutics ordering, immunization protocols
COVID-19 provider guide updates; Doing Well, Being Well Series: Breathwork for Wellness webinar; updated Indoor Masking FAQ, COVID-19 therapeutics ordering, immunization protocols; Free virtual training series about eating disorder treatment begins June 8, 2022 (CEUs available); CWM coverage of emergency cancer and behavioral health crisis treatment, effective Jan. 1, 2022; Fee-for-service rate increase for neonatal and pediatric intensive care professional services; Increased fee-for-service dispensing fee for monofocal glasses, effective July 1, 2022; Delegated nursing in OHA-licensed residential settings; Change log for Jan. 1, 2022 Prioritized List of Health Services; Join OHA's monthly Administrative Exams Collaborative starting June 7, 2022
5/13/2022Healthier Oregon Special Edition
May 16, 2022 mailing to CWM and CWM Plus members about July 1 transition to OHP Plus benefits; Frequently asked questions
5/6/2022Oregon WIC update: Tools for requesting medical formulas
Oregon WIC update: Tools for requesting medical formulas; Motivational interviewing for diabetes management; Health Evidence Review Commission seeks naturopathic physician for Value-based Benefits Subcommittee vacancy; Process change for calls to the Prior Authorization and Code Pairing Hotlines; Changes to fee-for-service provider revalidations; Provider resource updates; Recent rule revisions
4/22/2022Behavioral health providers, Urban Indian Health Programs and Tribal Behavioral Health Program grantees: Apply for COVID-19 workforce stability grants by May 4, 2022
Novel Coronavirus Coding recommendations; COVID-19 workforce stability grants; COVID-19 therapeutics webinar; Indoor masking FAQ; COVID-19 therapeutics infographics; No-cost webinar - Motivational interviewing for diabetes management; OHA seeks workgroup participants to inform OHP renewal process; OHA seeks Dental/Vision Rules Advisory Committee members; Clarification of OHP vision coverage; recent rule revisions
4/8/2022COVID-19 booster dose updates; 4/14 vaccine hesitancy webinar; sign up by 4/10 for PERM provider education webinars
New member fact sheets; Some CWX members reduced to CWM coverage in error; Webinar - Hesitance and Mistrust: Vaccine hesitancy for the six-month to four-year old populations; Booster dose resources, immunization protocols and updated masking requirements FAQ; More adults with have full OHP Plus benefits with Healthier Oregon; New substance use disorder treatment reimbursement codes and rate changes effective Jan. 1, 2022; PERM provider education webinars: Sign up by April 10, 2022; Fee-for-service rate change for Nexplanon®, effective Aug. 16, 2021; Certified Sexual Offense Therapists can now enroll to bill OHP for outpatient behavioral health services; Recent rule revisions; Provider resource updates
3/18/2022COVID-19 masking, isolation and quarantine guidance updates; OHA's pandemic recovery plan
COVID-19 provider guide update - Due date extension for initial planned community birth requests; updated health care masking FAQ, isolation and quarantine guidance; lifting of general indoor masking requirements; OHA launches pandemic recovery plan; Oregon HPV Dental Toolkit; Administrative Exams fee schedule; other provider resource updates
3/4/2022COVID-19 Therapeutics Provider Webinar: March 10, 2022, 10 to 11 a.m.
COVID-19 Therapeutics Provider Webinar; Masking requirements in health care settings FAQ updates and translations; Healthy Heart Ambassador Program facilitator training now available; Sodium Reduction in Communities Program Implementation Guide; Tobacco cessation counseling training for providers: Free and online (with CME); recent rule revisions; OHA submits final Medicaid 1115 waiver renewal application; 12-month eligibility for Oregon Health Plan post-partum benefits
2/18/2022Oregon Health Plan coverage of post-COVID (sometimes called “long COVID”) treatment
Oregon Health Plan (OHP) coverage of post-COVID (sometimes called “long COVID”) treatment; COVID-19 hazard pay and Cost of Living Adjustment (COLA) for Mental Health Adult Foster Homes; Masking requirements in health care settings; New Health Information Exchange Workgroup now open for applications: Applications due Feb. 25, 2022; Updated guide for hospital presumptive eligibility determinations
2/4/2022Expired Oregon DMV-issued driver licenses and vehicle registrations for NEMT drivers
Expired Oregon DMV-issued driver licenses and vehicle registrations for NEMT drivers; COVID-19 Therapeutics Operations Manual and updated Investigative Guidelines; recent rule revision and provider resource updates (including COVID-19 coding guide, National DPP billing, and authorization requirements for electrolysis and laser hair removal)
1/21/2022COVID-19 therapeutic updates; Oregon Resource Allocation Committee - Applications due 1/28/2022; recent rule revisions
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)
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
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