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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

  
  
1/27/2023
  
Monthly partner webinar series: Preparing for the COVID-19 Public Health Emergency (PHE) to end; From the Centers for Medicare & Medicaid Services: Resources for Medicare members about savings under the new prescription drug law; Fee-for-service reprocessing of CWM Plus postpartum professional and dental claims; Join OHA as we review the Substance Use Disorder (SUD) 1115 Demonstration Waiver, Feb. 8 and Feb. 9, 2023; New Early and Periodic Screening, Diagnostic and Treatment (EPSDT)  education session for behavioral health and Behavior Rehabilitation Service providers; provider resource updates; recent rule revisions

Archive

  
  
1/13/2023From the Centers for Disease Control and Prevention: Strategies, resources and data to encourage catch up on routine vaccinations
From the Centers for Disease Control and Prevention: Strategies, resources and data to encourage catch up on routine vaccinations; Join OHA's Rules Advisory Committee to discuss proposed changes to OHP telehealth rules; Join OHA's no-cost provider education sessions about EPSDT; Behavioral health rate increase updates; Other provider resource updates
12/30/2022Join OHA's no-cost provider education sessions about EPSDT in Oregon
Implementing Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit in Oregon; Join OHA's no-cost provider education sessions about EPSDT; Change log for 1/1/2023 Prioritized List; Provider resource updates; Recent rule revisions
12/16/2022Updated COVID-19 Immunization Protocols (bivalent booster and third vaccine doses for ages 6 months through 5 years)
Updated COVID-19 Immunization Protocols; Flu communications resources; Masking signage for businesses and health care settings;  Flu, COVID-19, RSV and holiday safety flyers and social cards for partners to share; Medicaid behavioral health rate increases effective July 1, 2022; RSV member fact sheet translations; Prioritized List change logs; Spanish translations of partner fact sheets (COFA Dental and Veteran Dental programs); Recent rule revisions

12/2/2022Oregon Health Plan coverage of palivizumab for Respiratory Syncytial Virus (RSV) prophylaxis expanded to high-risk children from 12 to 24 months of age, effective immediately
Respiratory Syncytial Virus (RSV) updates and resources; Preparing for the COVID-19 Public Health Emergency (PHE) to end: Join OHA and ODHS’s Dec. 13 webinar; Motivational interviewing trainings – Level 2 and Group Trainings Now Available (no-cost CME available);  EPSDT update: Coverage for OHP members under age 21 is changing Jan. 1, 2023; Oregon DRG hospitals: Fee-for-service reprocessing of outpatient claims planned for Dec. 10, 2022; Provider resource updates; Recent rule revisions
11/18/2022RSV, COVID-19, flu resources and updates
Respiratory infection resources and updates; If the holidays are hard: Resources for emotional and mental health; Join OHA's Provider Collaborative Webinar about CWM program updates Tuesday, Dec. 6, from 9 to 10 a.m.; Discontinuation of therapeutic foster care code S5146, effective March 1, 2023; updated Novel Coronavirus Coding recommendations
11/4/2022New partner toolkit to support people receiving benefits prepare for the end of the COVID-19 Public Health Emergency
Updated COVID-19 investigative guidelines; New partner toolkit to prepare for the end of the COVID-19 Public Health Emergency; Scam alert: Fake caller posing as OHA asking for personal health information; Medicaid coverage of outpatient gambling disorder treatment services; Language access requirements for health care providers; CWM coverage of immunosuppressant medications post-kidney transplant; Reminder about new dental-only OHP programs; Correction to Oct. 3 hospice rate memo
10/21/2022Protect Your Patients in October: Give Them a Flu Shot and COVID-19 Vaccine
From Centers for Medicare & Medicaid Services: Protect Your Patients in October: Give Them a Flu Shot and COVID-19 Vaccine; Novavax COVID-19 vaccine receives booster approval for some recipients; COVID-19 vaccine recommendations for children ages 5 through 17; Patient and provider COVID-19 vaccine resources; Preparing for the end of the federal COVID-19 PHE - Partner webinar recordings and material now available;  New OHP dental-only programs open Jan. 1, 2023
10/7/2022COVID-19 bivalent booster and seasonal flu vaccine administration - Billing codes and immunization protocols
Administration of COVID-19 bivalent booster and seasonal flu vaccines: Face-to-face assessments for individuals who receive 1915(i) and Behavioral Health Personal Care Attendant (BH PCA) services begin October 15, 2022; Preparing for the end of the federal COVID-19 PHE: Letters to OHP and Medicare Savings Program members; Reminders and best practices related to member billing prohibitions; Fee-for-service hospice rates effective October 1, 2022; Temporary rate increase for Enhanced Care Services, effective October 1, 2022; Provider resource updates; Recent rule revisions
9/23/2022COVID-19 bivalent vaccine boosters: Billing codes and updated fact sheets
Pfizer and Moderna COVID-19 bivalent booster vaccine administration for ages 12 and older, effective 9/1/2022; Fact sheet updates: Bivalent boosters; Masking requirements in health care settings FAQ update;  Webinar series: Preparing for the end of the federal COVID-19 Public Health Emergency continues Oct. 18 and Nov. 15, 2022; Complete Agreement to Pay forms before providing non-covered services to CWM members on or after July 1, 2022; Provider resource updates; Recent rule revisions
9/9/2022Novavax COVID-19 vaccine administration for ages 12 and older, effective 8/22/2022
Novavax age limit update; Partner webinar series about preparing for the end of the federal COVID-19 Public Health Emergency now starts Sept. 20, 2022; Reminder: Bill Oregon Health Plan (OHA or the CCO) last; Oct. 1, 2022 Prioritized List of Health Services now available; CCO-F: DCO members moving to CCOs, effective Jan. 1, 2023; Fee-for-service reprocessing of neonatal and pediatric intensive care service professional claims planned for week of Sept. 12, 2022; Recent rule revisions
8/26/2022OHA seeks members for Rules Advisory Committee to discuss changes to Pharmaceutical Services rules effective Jan. 1, 2023
Recordings: COVID-19 vaccine rollout for the 6-month to 5-year old populations; Spread the word: Monthly partner webinar series about preparing for the end of the federal COVID-19 Public Health Emergency; Community resources to improve health care services to people who are Deaf, DeafBlind or Hard of Hearing; OHA seeks members for Rules Advisory Committee to discuss changes to Pharmaceutical Services rules effective Jan. 1, 2023; Reminder: Member reimbursement for retroactive OHP Supplemental benefits; Billing for covered fall prevention programs; OHP coverage of hMPXV (human monkeypox virus) vaccines and testing, effective July 26, 2022; Billing for diabetes self-management and prevention programs; Recent rule revisions; Provider resource updates
8/12/2022Monthly partner webinar series: Preparing for the COVID-19 Public Health Emergency (PHE) to end
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
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