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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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Recent issues

  
  
In this issue
11/8/2019CCO 2.0 - Join OHA's Nov. 21 provider webinar
OHA to host CCO 2.0 provider webinar; CCO changes by county; fee-for-service prior authorization tips and resources; updated National Diabetes Prevention Program billing guidance
11/1/2019CCO 2.0 - Affected members and upcoming plan close notices
Clarification about members who will have 2020 CCO changes; communicating to patients about CCO affiliations; CCO closure notices to PrimaryHealth and Willamette Valley Community Health members mail Nov. 1, 2019; recent rule revisions

Archives

  
  
In this issue
10/23/2019Updates to CCO 2.0, vaping and public charge provider resources
CCO 2.0 updates - Continuity of care, member communication fact sheets; fee-for-service hospice rates effective Oct. 1, 2019; clarification about state-supplied vaccine coverage; public charge webinar for Oregon service providers; Transformation Center learning opportunities; vaping cessation resources
10/11/2019CCO 2.0 communications: Member letters begin mailing Oct. 15
CCO 2.0 member communications and resources for October and November: Mailings, material, provider page and more
9/23/2019CCO 2.0 updates: New provider, member resources
MS-DRG and LTC-DRG implementation status; reminder about payable procedure code/modifier combinations; recent rule revision
9/13/2019EDI System Maintenance 9/15/2019
Free online tobacco cessation counseling training with CME; fee-for-service prior authorization tips and resources; recent rule revisions
8/30/2019CCO 2.0 updates - Aug. 22 webinar recording, materials now available
New Medical Management Review fact sheet; controlling high blood pressure webinar - CMES available for one more month; billing for independent ESRD facilities; reminder about 1/1/2019 changes to fee-for-service substance use disorder treatment codes
8/15/2019CCO 2.0 updates - Join OHA's Aug. 22 webinar
Behavioral health rule advisory committees; August 2019 rule revisions
7/31/20192020-2024 coordinated care updates
Enroll prescribers with OHA for continued prescription access; controlling high blood pressure webinar; online tobacco cessation counseling training; Individual Adjustment Request mailbox closing; fee-for-service prior authorization updates; changes to fee-for-service opioid coverage criteria effective 10/1/2019
7/2/2019OHA will deny prescriptions written by non-OHP providers starting 9/3/2019
Concierge care and OHP coverage; hospice services do not require prior authorization; 2019 changes to fee-for-service substance use disorder treatment codes; bill OHP for preventive medicine counseling services; use only black ink on paper claims and medical documentation; enter prescriber's NPI on all prescription claims; recent rule revisions
6/3/2019HERC removes OHP opioid tapering requirement for neck and back pain, effective 10/1/2019
Everyone who writes prescriptions for OHP members must enroll with OHA or their local CCO; controlling high blood pressure webinar; online tobacco cessation counseling training; upcoming changes to fee-for-service authorization of outpatient physical, occupational and speech therapy services; billing Medicare-Medicaid claims on the UB-04 paper claim form; enter prescriber's NPI on all prescription claims; recent rule revisions
4/30/2019Everyone who writes prescriptions for OHP members must enroll with OHA or their local coordinated care organization
Independent review of proposed changes to OHP chronic pain benefit coverage; enter contact information on Provider Web Portal prior authorization requests; completing CMS-1500 paper claims; do not bill OHA for services covered by the member's CCO; enter prescriber's NPI on all prescription claims; recent rule revisions
3/29/2019Proposed changes to OHP chronic pain benefit coverage on hold
Enroll prescribers with the Oregon Health Plan; how to verify managed care enrollment of OHP members; paper claim reminders; recent rule revisions
2/28/2019Survey for Oregon Health Plan application feedback ends March 21, 2019
Enroll prescribers with OHP; how to submit physical health prior authorization requests; billing for maternity case management of CCO members
1/25/2019Reminder from CMS – Qualified Medicare Beneficiary billing requirements
Enroll prescribers with OHP; new web portal claim search requirements; benefits of electronic billing; changes to prior authorization criteria for hepatits C direct-acting antivirals; recent rule revisions
12/21/2018Changes to the Prioritized List of Health Services effective 1/1/2019
Medicaid EHR Incentive Program; OHP prescriber enrollment requirements; National Diabetes Prevention Program coverage; Medication-Assisted Treatment coverage; billing for maternity care using global codes; Version 36 MS-DRG grouper implementation delayed; recent rule revisions
11/30/2018Chronic Pain Taskforce meets 12/5/2018
Change to sterilization consent requirements effective 1/1/2019; ASCs can bill OHA for post-procedure LARC placement effective 1/1/2019; recent rule revisions
10/26/2018New survey asks for provider feedback about health care interpretation
Chronic Pain Taskforce update; new Health Evidence Review Commission website links; recent rule revisions
9/28/2018Changes to the Prioritized List of Health Services effective 10/1/2018
Chronic Pain Taskforce update; session expiration messages coming to Provider Web Portal; how to fax prior authorization requests to OHA; prescriber enrollment requirement update; recent rule revisions
8/31/2018Proposed changes to OHP chronic pain benefit coverage
Where to send paper claims, provider enrollment and prior authorization information; prior authorization requirements for fee-for-service physician-administered biologic drugs for autoimmune conditions; fee-for-service claim reprocessing to apply 2018 GPCI values; recent rule revisions
7/27/2018HERC to consider chronic pain diagnoses, services for Oregon Health Plan
Prescription Drug Monitoring Program enrollment is mandatory for all licensed health care professionals with a DEA number; Oregon P&T Committee accepting applications; improvements to OHP provider enrollment processes; Emergency Flag on CMS-1500 and OHP 505 paper claims; enroll prescribers with OHP; recent rule revisions
6/29/2018Reproductive Health Equity Act services effective 4/1/2018
Web-based pain education module; nursing facility room and board rates effective 7/1/2018; new vaccine codes open for fee-for-service billing; changes to fee-for-service coverage of J9035; doulas can enroll to directly bill OHA starting 7/1/2018; recent rule revisions
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