Anyone using this network expressly consents to such monitoring andor recording. Use of this network is restricted to authorized users only and must comply with oregon health authority privacy and security policies. Manuals, forms and resources oregon medicaid, medicare. Ohp client agreement to pay for pharmacy services ohp form 3166 ohp filling prescriptions for members moving to new ccos. Policy changes that have occurred since the effective date noted are announced in ihcp provider bulletins and banner pages. State quality measures, which oha has agreed to report to the centers for medicare and medicaid services cms as part of oregon s 1115 medicaid waiver. Also check the prioritized list of health services to see if ohp will cover the requested service for the condition being treated.
Cawem is a benefit package that covers emergency medical services only. This booklet is your list of the drugs that are covered. Manuals it offers daytoday operating instructions, policies, and procedures based on statutes and regulations, guidelines, models, and directives. Health insurance, including medicare and tricare, generally pays first, to the limit of coverage liability. Click here to access radmd or call 8888795922 for medicaid, 8006422798 for medicare. Use the links below to view the most recent changes in a pdf format. Medicaid electronic health records incentive program manuals and other resources. Dmap extended medicaid eligibility to all state residents with incomes up to 8% of the federal poverty level fpl, as well as children whose family income is up to 300% of the fpl.
The complex intersection of medicaid and 340b the intersection of 340b and medicaid is one of the most complex and significant areas within any health centers 340b program, for two reasons. When in doubt, refer to the pharmaceutical services provider guidelines at. Only services that are included on the enclosed authorization will be reimbursed. Behavioral health providers can download the metro area behavioral health provider manual. Jan 01, 2020 integrated delivery system ids under health share of oregon, a coordinated care organization cco certified by the oregon health authority oha to serve ohp medicaid enrollees in clackamas, multnomah and washington counties. Policies and procedures college of pharmacy oregon state.
The fee for ffs drugs is specified in oregon medicaids pharmacy manual. The oregon health plan ohp is the oregon medicaid program administered by the oregon. These manuals require javascript and cookies enabled. Pt medicaid dental providers please contact your dental care organization dco for contracting information. View the most recent published manual at the link below. In an apd context, an applicant must meet all of the osipm eligibility factors except the citizenalien status and ssn requirements. Uniform new mexico hepatitis c virus checklist repeal and replace mad 634 form. Medicaid prescription drug coverage includes federal upper limits, program releases and pricing information. Coordination of benefits and third party liability. Providers overview new mexico human services department. Please refer to the oregon secretary of state website. The indiana health coverage programs ihcp medical policy manual contains information about indiana medicaid policies.
Comments about the manuals and bulletins may be directed to. Arkansas medicaid dur board edits approved at the october 15, 2014 meeting. Nachc 340b manual for health centers, second edition 57 chapter 9 medicaid and 340b a. Call the phone number listed on your cco or plan id. The oregon health plan ohp is the oregon medicaid program administered by the division of medical assistance programs dmap at the state of oregon. Kaiser permanente provider manual 2009 11 section 11 kaiser permanente oregon plus please note this patient is an oregon health plan recipient. The formulary list provides a directory of all the preferred medications currently approved for health sharecareoregon members. A cco is a network of all types of health care providers physical health care, addictions and mental health care and dental care providers who work together in their local communities to serve people. Health care services are provided depending on where they rank on the prioritized list of health services. Other third parties generally pay after settlement of claims medicaid is last payer for services covered under medicaid, except in those limited. Also see our frequently asked questions about ohp feeforservice prescription coverage and oregon medicaid pharmacy quick reference includes current. A group of pharmacists and doctors decide which drugs should be in the formulary. Oregon medicaid pharmacy quick reference state of oregon.
Oregon medicaid pharmacy quick reference effective december 2020. Use the link below to view the formulary in a pdf format. Oregon pharmacy call center ffs 8882022126 phone 8883460178 fax coordination of benefits. The oregon health plan and coordinated care organizations ccos the oregon health plan ohp is the oregon medicaid program administered by the oregon health authority oha. When in doubt, refer oregon medicaid pa criteria, may 1, 2016 oregon. When an individual alleges a disability that would meet the ssa disability requirements for supplemental security income ssi or social security disability insurance ssdi benefits, oregon is required to make a presumptive medicaid disability determination within 90 days of the individuals date of request. The pharmacy claim instructions handbook is designed to help those who bill the oregon health authority. This document provides general information regarding vaccination coverage through careoregons medicaid and medicare advantage plans. The careoregon provider manual can be used by careoregonoregon health plan and careoregon advantagemedicare contracted providers. Learn about cco metrics and how plans perform on the cco metrics page of the oha website. As oregon health plan participants, trillium members have certain rights and responsibilities pertaining to their healthcare. Our secure website for providers lets you access claims, request and check the status of preauthorization, and view member benefits, any time.
Oregon medicaid pharmacy quick reference effective january 2020. Introduction the pharmacy 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. Apd program manual citizen alien waived emergent medical effective 12114. Oregon prescription drug program see oar 4101212000 through 4101212065. The fee for ffs drugs is specified in oregon medicaid s pharmacy manual.
In oregon, the medicaid program is called the oregon health plan ohp. The fee for managed care drugs is negotiated between 340b pharmacies and managed care plans. Meeting info meetings are generally held on the first thursday of the month from 1 p. This will give you stepbystep instructions so that oha can pay you, the provider, more quickly. Physical health providers can download the careoregon provider manual. Oregon administrative rules and supplemental information for the oregon health plan durable medical equipment, prosthetics, orthotics and supplies program chapter 410 division 122. Click here to access radmd or call 8888795922 for medicaid, 8006422798 for medicare the prioritized listing can be viewed on linefinder. Trillium preferred drug list pdl list of covered drugs oregon health plan pdf. Manuals, forms and resources trillium community health plan. If you have received your personal identification number letter. In hawaii, state medicaid officials recently told 340b covered entities to begin submitting a quarterly spreadsheet listing all non340b drugs given to medicaid managed care beneficiaries and paid for by a managed care plan.
The careoregon provider manual can be used by careoregon oregon health plan and careoregon advantagemedicare contracted providers. Oregon medicaid feeforservice provider contacts list ohadhs. The state health care authoritys secure website is intended for. The oregon health plan ohp is the oregon medicaid program administered by the division of medical assistance. Oregon pharmacy call center ffs 8882022126 phone 8883460178 fax coordination of benefits drug prior authorizations technical questions posprodur actual average acquisition cost rates. Eligibility has been expanded so more people can receive medical assistance. Print it and send it by mail or secure fax to 5035748142. Ohsu health services administers over 41,000 medicaid lives. For services covered feeforservice by the oregon health authority, use the provider web portal or msc 3971 updated march 2018. Trillium preferred drug list pdl list of covered drugs oregon health plan. Policies and procedures college of pharmacy oregon.
Oregon medicaid pharmacy quick reference effective january 2020 drug formulary. If you have a suggestion concerning the information in the provider manuals, please let us know. All active and available drugs reported by first databank are included if they provide a federal rebate or are preferred. 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 manual has information on the following topics. The manual focuses on the navigation, access, and usage functions of the or mmis application and supports the business processes carried out by the dhs staff. Find allcare cco oregon health plan providers allcare cco. In 2003, we transformed the cms program manuals into a web userfriendly presentation and renamed it the cms online manual system. This users manual describes how department of human services dhs staff use the application processing features of the oregon medicaid management information system or mmis. This is the oregon health plan feeforservice preferred drug list and drug prior authorization pa searchable database. The pharmacy help desk provides resources for providers, pharmacists, pharmacy technicians and supporting staff. Experiences in four states prepared by ryan padrez, tanisha carino, ph. June, 2020 6 dental commercial dental customer service phone. College of pharmacy oregon state university corvallis, or 97331 phone.
Changes to existing prior authorization pa criteria or edits. If an individual has already been determined to be disabled by the. Introduction 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. Complex imaging, ct, pet, mra, mri, and high tech radiology procedures need to be authorized by nia. At this time, approximately 50,000 people are receiving.
Oregon medicaid ffs drug class list state of oregon. Some vaccines are covered under the medical benefit inferring office administration and others are covered under the pharmacy benefit meaning dispensed at a network pharmacy. Oregon administrative rules and supplemental information administered by the health systems division. Requests for a serviceproduct based on exceptional needs can be entered on the secure provider portal. We want the manuals and the medicaid information bulletins to assist you as a medicaid provider. Receive program updates by text or email please specify which programs you are interested in. Oregon medicaid ffs drug class list this is the oregon health plan feeforservice preferred drug list and drug prior authorization pa searchable database. Print book function for robohelps webhelp is licensed from. You may elect to receive notifications by email of meeting schedules, document postings and newsletters by subscribing to the osupharmdi listserv. For information on billing and rates, expedited authorization ea codes, and the state maximum allowable cost list smac, please visit the prescription drug program on our. Kaiser permanente provides outpatient medical services for this patient.
When a person has medicaid and there is another liable third party. Provides employment path services, supported employment individual employment support, waiver case management, discoverycareer exploration services, environmental safety modifications, family training, individual directed goods and services, specialized medical supplies, supported employment small group employment support, vehicle modifications for individuals with iddd ages 017. National provider identifier lookup all pharmacy claims should include the npi of the prescribing provider in the prescriber id field. Ohp client agreement to pay for pharmacy services fact sheet. The prior authorization handbook provides stepbystep instructions. Trillium medicaid provider manual trillium community health plan. As a member of your cco, you have medicaid prescription drug coverage under the oregon health plan ohp. For matters of this manual, all members of a careoregonaffiliated health plan cco or medicare will be referenced as careoregon members.
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