Retroactive authorization for payment can be granted after the service is provided only in the following circumstances:

1. (1) The person was not yet eligible for Medicaid/CHIP at the time the services were provided. Payment can be made if the services are covered Medicaid/CHIP services and the client's eligibility is extended back to the date the hospital provided services. See: the Hospital Services Supplemental Information on the Division of Medical Assistance Programs (Division) website for additional billing information.
2. (2) If another insurer denied the claim because the service is not covered by that insurer, and the hospital did not seek prior authorization because it had good reason to believe the service was covered by the insurer. Payment can be made by the Division if the services are covered by Medicaid. See: the Hospital Services Supplemental Information on the Division website for additional billing information.

Statutory/Other Authority

ORS 413.042

Statutes/Other Implemented

ORS 414.065

History

OMAP 70-2004, f. 9-15-04, cert. ef. 10-1-04
OMAP 34-1999, f. & cert. ef. 10-1-99
HR 42-1991, f. & cert. ef. 10-1-91