1. (1) The Center shall only pay claims submitted by an enrolling or ancillary provider for a client.
2. (2) The Center shall reimburse an enrolling or ancillary provider an amount up to the Medicare reimbursement rate for the Portland metropolitan area for WW Program approved CPT codes, on a fee-for-service basis.
3. (3) A federally qualified health center or rural health center shall not be paid at their Prospective Payment System (PPS) rate, but will be paid at the reimbursement rate described in section (2) of this rule.
4. (4) The Center payments for WW Program provider services, unless in error, constitute payment in full.
5. (5) The Center may not make payment on claims that have been assigned, sold, or otherwise transferred, or on which a provider of billing services receives a percentage of the amount billed or payment authorized, including claims that have been transferred to a collection agency or individual who advances money to a provider for accounts receivable.

Statutory/Other Authority

ORS 413.042

Statutes/Other Implemented

ORS 413.042 & 431.250

History

PH 27-2014, f. & cert. ef. 10-10-14
PH 12-2014(Temp), f. & cert. ef. 4-18-14 thru 10-15-14
PH 1-2009, f. & cert. ef. 2-13-09