Medical billing services in Oregon

Billing in Oregon: what's different

The rules below change how a claim is filed and paid in Oregon. Each line links to the official page it was read from, and the date at the top of this page is when it was last checked.

Rules that change how Oregon claims are billed

• CCO contracts ask for the first bill within four months of the service⁸

  Under OAR 410-141-3565 and the CCO contract, providers submit initial billings to the coordinated care organization within four months of the date of service, stretching to 12 months only for retroactive deletions or enrollments, pregnancy, Medicare as primary payer, third-party resource cases and other delays outside the provider's control. OHA's 2020 guidance clarified that the four months cover the initial claim only, that resubmission of a denied claim for correction falls outside that window, and that CCOs should consider reprocessing claims denied because a correction arrived after four months. Each CCO publishes its own correction window in its provider manual, so two neighboring CCOs can run different clocks for the same practice.

• Home health agencies report every visit to OHA within ten days of month end¹⁵

  Since January 1, 2024 an Oregon Medicaid home health agency has to send OHA a completed EVV Reporting Template no later than ten days after the end of each month, covering all completed visits. Each row carries the claim status, how the visit was captured (automated EVV or manual entry), the member's Oregon Health ID, the rendering provider ID, the name of the person who actually gave the care, the date, start and end times, the start and end GPS coordinates or addresses, up to three revenue codes and the ICN for an adjusted claim. A manually captured visit needs a reason code such as the worker forgetting to clock in, a device error, no internet connection or telephony being unavailable.

• Homecare workers log time in OR PTC DCI, not on paper vouchers¹⁶

  The Oregon Provider Time Capture project replaced paper vouchers for homecare workers and personal care attendants with OR PTC DCI, the Direct Care Innovations system, after a pilot that began August 1, 2021 and a statewide start on September 12, 2021. Authorizations are still created in the state mainframe and then carried into OR PTC DCI, workers enter time and mileage there, and the system was built to meet the federal EVV requirement, so an agency that also employs homecare workers under Aging and People with Disabilities authorizations runs two EVV tracks.

• The check-cut date is what the regulator counts⁹

  Oregon's insurance regulator told health insurers in 2005 how it measures the 30-day clean claim rule: the check-cut date is prima facie evidence of payment, compliance is the number of days between the date the claim was received and the date the check was cut, mailroom procedures are examined to confirm payments go out within 30 days, and a 30th day that falls on a weekend or holiday means the check is expected the next business day. The statute was then numbered ORS 743.866 and is now ORS 743B.450, so an unpaid clean claim is escalated with receipt date and check date side by side.

• OHP has run under a demonstration waiver since 1994 and pre-assigns members⁴

  CMS's 2024 state tables describe the Oregon Health Plan as a statewide program combining a full-benefit managed care organization with managed long-term services and supports, operating since February 1, 1994 under section 1115(a) demonstration authority together with 1932(a), 1915(b), 1915(c), 1915(i), 1915(j) and 1915(k), with the current waiver running to September 30, 2027. Medicaid enrollees are pre-assigned to a plan. Enrollment is mandatory for low-income adults, limited-benefit members and children with special health care needs and voluntary for aged, blind or disabled members, non-disabled children, full dual eligibles, Native American members and children in foster care.

• CMS signed off on Oregon's personal care EVV in 2021¹⁷

  In a letter dated November 2, 2021, CMS told the Oregon Health Authority that the state met the EVV requirements of section 1903(l) of the Social Security Act for personal care services rendered as of October 1, 2021 under the state plan personal care benefit, 1915(c) waivers, the 1915(i) and 1915(k) state plan options and 1915(j) self-directed care, so no federal matching reductions apply to those services. The letter reserved the right to apply reductions if the system does not match the state's attestation, and it requires an updated survey if Oregon adds a personal care authority.

Services for Oregon practices

Remitwright serves Oregon practices remotely, inside the practice management or EHR system the practice already uses. A dedicated biller works the account; nothing is pooled. Each service below explains what that biller does.

• Medical billingClaims worked by one named biller
• CredentialingEnrollment, CAQH and PECOS kept current
• Eligibility verificationCoverage and benefits checked before visits
• Prior authorizationAuths requested, tracked, attached to claims
• Denial managementEvery denial read, worked and appealed
• A/R follow-upUnpaid claims chased before filing limits