Guidelines for using the Prescription Drug Invoice 1.2 Universal Claim Form.

1. (1) When a paper claim form is needed, this form is used to bill for all pharmacy services, home blood glucose monitors, and related diabetic supplies. These services must be billed with a National Drug Code (NDC).
2. (2) The provider may bill on the form when a valid Medical Care Identification has been presented (Refer to OAR 410-120-1140 Verification of Eligibility).
3. (3) All completed 1.2 Universal Claim Forms must be mailed to the Health Systems Division (Division).

4. (4) All other durable medical equipment and certain Enteral/Parenteral Nutrition and IV Services must be billed on the CMS-1500, using the billing instructions found in the Division’s Durable Medical Equipment and Medical Supplies administrative rules (division 122) and Supplemental Information, and the Division’s Home Enteral/Parenteral Nutrition and IV Services Administrative rules (division 148) and Supplemental Information. These services are billed with HCPCS procedure codes.

   NOTE: Publications referenced are available from the agency.

Statutory/Other Authority

ORS 413.042 & 414.065

Statutes/Other Implemented

ORS 414.065

History

DMAP 11-2018, amend filed 03/02/2018, effective 03/02/2018
DMAP 14-2011, f. 6-29-11, cert. ef. 7-1-11
DMAP 34-2008, f. 11-26-08, cert. ef. 12-1-08
OMAP 18-2004, f. 3-15-04 cert. ef. 4-1-04
OMAP 40-2003, f. 5-27-03, cert. ef. 6-1-03
OMAP 20-2003, f. 3-26-03, cert. ef. 4-1-03
HR 20-1994, f. 4-29-94, cert. ef. 5-1-94
HR 29-1990, f. 8-31-90, cert. ef. 9-1-90