Oregon Medicaid



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Oregon Medicaid

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Managed Care in OregonMedicaid

www.medicaid.gov

Overview of Current Managed Care Programs. In July 2011, nearly all Medicaid
beneficiaries were enrolled in fully-capitated managed care plans. In 1994,
Oregon phased out the Physician Care Organization program (a limited benefit
prepaid plan model) in the favor of the full-risk, capitation-based Oregon Health
Plan, …

Oregon Verification Plan – Medicaid.gov

www.medicaid.gov

MAGI-BASED ELIGIBILITY VERIFICATION PLAN. Medicaid and CHIP. Medicaid
& CHIP. State: Oregon. Last updated: 07/05/2016. Section A. Verification
Procedures for Factors of Eligibility. Eligibility Factor. Self-. Attestation. Accepted
without. Additional. Verification. (Y/N). Self-. Attestation. Accepted with. Post-
Eligibility.

Oregon Medicaid Encounter Data Submisson Guidelines – Oregon.gov

www.oregon.gov

Encounter Data Submission Guidelines. HEALTH SYSTEMS DIVISION.
Instructions for Oregon. Medicaid Prepaid Health Plans and Coordinated Care.
Organizations. June 2017 …

Oregon Medicaid Professional Billing Instructions – Oregon.gov

www.oregon.gov

The Professional Claim Instructions handbook is designed to help those who bill
the Oregon Health Authority. (OHA) for Medicaid services submit their claims
correctly the first time. This will give you step-by-step instructions so that OHA can
pay you, the provider, more quickly. Use this handbook with the General Rules.

Oregon Medicaid Pharmacy Quick Reference – Oregon.gov

www.oregon.gov

Oregon Medicaid Pharmacy Quick Reference (updated September 2017). When
in doubt, refer to the Pharmaceutical Services provider guidelines at www.oregon
.gov/OHA/hsd/ohp/pages/policy-pharmacy.aspx. HEALTH SYSTEMS DIVISION.
Integrated Health Programs. Bill all other payers first. Bill Medicaid (OHA or the …

Oregon Medicaid PA Criteria, July 1, 2017.pdf – Oregon.gov

www.oregon.gov

Oregon Medicaid Pharmaceutical Services. Prior Authorization Criteria. HEALTH
SYSTEMS DIVISION. Prior authorization (PA) criteria for fee-for-service
prescriptions for Oregon Health Plan clients. July 1, 2017 …

Oregon Medicaid Institutional Billing Instructions – Oregon.gov

www.oregon.gov

Institutional Billing Instructions. HEALTH SYSTEMS DIVISION. Billing instructions
for Provider. Web Portal and UB-04 institutional claim formats for. Oregon
Medicaid providers. June 2017 …

Oral Health in Oregon's CCOs – Oregon.gov

www.oregon.gov

Mar 31, 2017 worse health outcomes. Recognizing the importance of oral health across the
lifespan, Oregon is one of only 13 states that offers comprehensive dental
benefits to all adults with Medicaid, as well as children.†. In addition to being the
first report of oral health services in OHP CCOs, much of the data in this …

Provider Matters – Oregon.gov

www.oregon.gov

Monthly updates about claim processing, policy and resources for Oregon.
Medicaid providers. June 16, 2017. In this issue… • Important reminders. •
Training and technical assistance. • Claims. • Rules and program changes. •
Need help? Important reminders. Verify OHP eligibility and CCO enrollment on
the date of service.

Top fee-for-service (FFS) billing errors and resolutions – Oregon.gov

www.oregon.gov

Jan 3, 2017 status using the Provider Web Portal at https://www.or-medicaid.gov, you will see
HIPAA Adjustment. Reason Codes (ARCs). When these messages display for
denied or partially-paid claims, they may indicate errors you need to research
and correct in order to resubmit or adjust the claim. Other errors are …

The Oregon Health Authority May Be Providing Medicaid Benefits to

sos.oregon.gov

May 17, 2017 The Oregon Health Authority May Be Providing Medicaid Benefits to Ineligible
Recipients1. During the course of audit work, we detected a risk where a
substantial number of current Medicaid recipients may be ineligible to receive
assistance. As of May 1, 2017 preliminary analysis by the Oregon.

The Medicaid Program Could Have Achieved Savings if Oregon

oig.hhs.gov

THE MEDICAID PROGRAM. COULD HAVE ACHIEVED SAVINGS IF. OREGON
HAD APPLIED. MEDICAL LOSS RATIO STANDARDS. SIMILAR TO THOSE
ESTABLISHED. BY THE AFFORDABLE CARE ACT. Gloria L. Jarmon. Deputy
Inspector General for Audit Services. April 2016. A-09-15-02033. Inquiries about
this …

Summary of Benefits for Oregon, MEDICAID – HRSA

ersrs.hrsa.gov

Yes. 1 x every 5 years. Only for permanent molars; age 15 years old and younger
. Space maintainers. Yes. The Division may not reimburse lost or damaged
removable space maintainers. InsureKidsNow.gov. 1 of 5. Print date: January 1,
2018. Data as of: 05/08/2017. Summary of Benefits for Oregon, MEDICAID …

Oregon Mental Health and Substance Abuse Services in Medicaid

store.samhsa.gov

Information as reported by state Medicaid and SCHIP agencies. Oregon page 1
of 5. Mental Health and Substance Abuse Services in. Medicaid and SCHIP in
Oregon. As of July 2003, 398,874 people were covered under Oregon's Medicaid
/SCHIP programs. There were. 380,546 enrolled in the Medicaid program and …

Department of Health and Human Services, Centers for … – CMS.gov

www.cms.gov

Department of Health and Human Services. Centers for Medicare & Medicaid
Services. Medicaid Integrity Program. Oregon Comprehensive Program Integrity
Review. Final Report. December 2014. Reviewers: Barbara Davidson, Review
Team Leader. Todd Chandler. Margie Charleston. Annette Ellis. Joel Truman,
Review …

Cover Oregon Financial Help Booklet

www.wyden.senate.gov

If you purchase a private insurance plan through Cover Oregon, you may qualify
CoverOregon.com. • Choose to take the maximum tax credit each month — or
take just part of it. • Pay a lower premium each month in 2014. • Get a statement
…. The Oregon Health Plan and Healthy Kids are Oregon's Medicaid programs.

Oregon Women's Health Statistics – Centers for Disease Control and …

www.cdc.gov

20.0 teen birth rate (births per 1,000 women 15-19 years old) (2014)2. 31,000
unintended pregnancies (2010)3. Services for Women. Activity. Does it exist in
Oregon? Medicaid Family Planning Waiver/State Plan Amendment4. Yes. Waiver
Includes Teens. Yes. HHS Unintended Pregnancy Activities5. Yes. 6/18 Initiative.
No.

Premium Assistance Under Medicaid and the Children's Health …

www.dol.gov

If you or your children are eligible for Medicaid or CHIP and you're eligible for
health coverage from your employer, your state may have a … dependents might
be eligible for either of these programs, contact your State Medicaid or CHIP
office or dial 1-. 877-KIDS NOW or …. MISSOURI – Medicaid. OREGON
Medicaid.