Or. Admin. R. 333-010-0135 - Provider Enrollment

(1) This rule applies only to providers participating in ScreenWise BCC through an approved provider agreement with the Center.
(2) An individual or organization must meet applicable licensing or regulatory requirements set forth by federal and state statutes, regulations, and rules to be enrolled and to bill as a provider. In addition, all providers of services within the State of Oregon must have a valid Oregon business license if such a license is a requirement of the state, federal, county or city government to operate a business or to provide services.
(3) An individual or organization that is currently subject to sanctions by the Authority or the federal government is not eligible for enrollment.
(4) A ScreenWise BCC agency number will be issued to an individual or clinic upon:
(a) Completion of the application and submission of the required documents;
(b) The signing of the provider agreement by the provider or person authorized by the provider to bind the organization or individual to comply with these rules;
(c) Verification of licensing or certification; and
(d) Approval of the application by the Center.
(5) Issuance of an agency number establishes enrollment of an individual or organization as a provider for ScreenWise BCC services.
(6) If a provider changes address, business affiliation, licensure, ownership, certification, billing agents, registered name, or Federal Tax Identification Number (TIN), the Center must be notified in writing within 30 days of the change. Failure to notify the Center of a change of TIN may result in the imposing of a fine. Changes in business affiliation, ownership, registered name, and TIN may require the submission of a new application. Payments made to providers who have not furnished such notification may be recovered.
(7) Providers of services outside the state of Oregon will be enrolled under the following conditions:
(a) The provider is appropriately licensed or certified by the provider's state;
(b) The provider lives in a state contiguous to Oregon, and is within seventy-five miles of the Oregon border.
(8) Provider termination:
(a) The provider may terminate enrollment at any time. The request must be sent to the Center in writing, via certified mail, return receipt requested. The notice shall specify the agency number to be terminated and the effective date of termination. Termination of the provider enrollment does not terminate any obligations of the provider for dates of services during which the enrollment was in effect.
(b) ScreenWise BCC provider terminations or suspensions and subsequent recovery of any payments made by the Center may be for, but are not limited to, the following reasons:
(A) Breaches of the medical services agreement;
(B) Failure to comply with the statutes, regulations and policies of the Authority, and federal or state regulations that are applicable to the provider;
(C) Loss of the appropriate licensure or certification.
(9) The provider is entitled to a contested case hearing to determine whether the provider's agency number will be revoked.
(10) In the event of bankruptcy proceedings, the provider must notify the Center in writing within 15 days.
(11) Providers must receive information about administering the ScreenWise BCC from a ScreenWise BCC representative before services are initiated.

Notes

Or. Admin. R. 333-010-0135
PH 9-2008, f. & cert. ef. 6-16-08; PH 11-2016, f. & cert. ef. 4/1/2016

Stat. Auth.: ORS 413.042

Stats. Implemented: ORS 413.042

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