1. (1) All providers seeking reimbursement from the Authority, a PHP, CCO, or a county pursuant to a county agreement with the Authority for the provision of covered services or items to eligible recipients, must comply with:

   1. (a) These rules, OAR 943-120-0300 to 943-120-0350: and

   2. (b) The applicable rules or contracts of the specific programs described below:

      1. (A) Programs administered by the Division of Medical Assistance Programs (Division) including the OHP medical assistance program and the CHIP program that reimburse providers for services or items provided to eligible recipients, subject to OAR chapter 410 divisions 120 and 141 and provider rules in chapter 410 applicable to the provider’s service category;
      2. (B) Programs administered by the Addictions and Mental Health Division (AMH) that reimburse providers for services or items provided to eligible AMH recipients (OAR chapters 309 and 415); or
      3. (C) Programs administered by Aging and People with Disabilities (APD) that reimburse providers for services or items provided to eligible APD recipients (OAR chapter 411).

2. (2) Providers must submit visit data pursuant to program-specific rules or contract. Authority programs use visit data to monitor service delivery, planning, and quality improvement activities. Visit data is not a HIPAA transaction and is not a claim for reimbursement.

   [Publications: Publications referenced are available from the agency.]

Statutory/Other Authority

ORS 413.042

Statutes/Other Implemented

ORS 414.065, 414.115; 414.125; 414.135; & 414.145

History

OHA 8-2012, f. 10-30-12, cert. ef. 11-1-12
OHA 20-2011, f. 8-30-11, cert. ef. 9-1-11
OHA 14-2011(Temp), f. & cert. ef. 7-1-11 thru 12-27-11