Or. Admin. R. 333-010-0220 - Provider Enrollment

(1) An individual or organization that wishes to be an enrolling provider or an ancillary provider with the WW Program shall apply to the Center on a form prescribed by the Center.
(2) In order to be eligible for enrollment, an individual or organization shall:
(a) 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; and
(b) Meet applicable licensing or regulatory requirements set forth by federal and state statutes, regulations, and rules to be enrolled and to bill as a health care provider.
(3) A laboratory or any other entity that does laboratory tests must provide evidence that it is CLIA certified in order to be a provider or an ancillary provider.
(4) An individual or organization that is currently subject to sanctions by the Authority or the federal government is not eligible for enrollment.
(5) Upon receipt of an application the Center shall verify the information and determine if the individual or organization is eligible to be an enrolling or ancillary provider.
(6) If the Center approves an application, an individual or organization shall:
(a) Sign a medical services agreement that requires the provider to comply with these rules; and
(b) Be issued a BCCP/WW Program agency number.
(7) An enrolling or ancillary provider may not offer services to a client prior to receiving information from a Center WW Program representative about administering the WW Program.
(8) An enrolling provider or ancillary provider shall notify the Center in writing within 30 days of the change if it changes its address, business affiliation, licensure, ownership, certification, billing agents, registered name, or Federal Tax Identification Number (TIN). Changes in business affiliation, ownership, registered name, and TIN may require the submission of a new application. Payments made to an enrolling provider or an ancillary provider who has not furnished such notification may be recovered by the Center.
(9) An enrolling provider or an ancillary provider shall notify the Center in writing of a bankruptcy proceedings within 15 days.
(10) An individual or organization outside the state of Oregon may be eligible for enrollment if the individual or organization:
(a) Is appropriately licensed or certified in its state; and
(b) Is located in a state contiguous to Oregon, and is within 75 miles of the Oregon border.
(11) An enrolling provider or an ancillary provider may terminate enrollment at any time by sending a written termination notice to the Center, via certified mail, return receipt requested. The notice shall specify the agency number to be terminated and the effective date of termination. Termination of a provider enrollment does not terminate any obligations of the provider for services provided to a client prior to the effective date of the termination.

Notes

Or. Admin. R. 333-010-0220
PH 1-2009, f. & cert. ef. 2-13-09; PH 12-2014(Temp), f. & cert. ef. 4-18-14 thru 10-15-14; PH 27-2014, f. & cert. ef. 10-10-14

Stat. Auth.: ORS 413.042

Stats. Implemented: ORS 413.042, 431.250

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