1. (1) The 1.2 Universal Claim Form is the required billing form for pharmacies billing on a paper claim. Use the standard instructions for completion of the 1.2 Universal Claim Form.
2. (2) Enter all applicable information for billing of prescription drug claims for clients on the Oregon Health Plan.

Statutory/Other Authority

ORS 413.042, 414.034 & 414.065

Statutes/Other Implemented

ORS 414.065

History

DMAP 11-2018, amend filed 03/02/2018, effective 03/02/2018
OMAP 40-2003, f. 5-27-03, cert. ef. 6-1-03
OMAP 1-1999, f. & cert. ef. 2-1-99
HR 23-1995, f. 12-29-95, cert. ef. 1-1-96
HR 2-1995, f. & cert. ef. 2-1-95
HR 20-1994, f. 4-29-94, cert. ef. 5-1-94
HR 14-1993, f. & cert. ef. 7-2-93
HR 29-1990, f. 8-31-90, cert. ef. 9-1-90, Renumbered from 461-016-0280
AFS 56-1989, f. 9-28-89, cert. ef. 10-1-89