Or. Admin. R. 410-148-0140 - Billing Information

(1) For medications:

(a) Pharmacies billing electronically bill through the Division of Medical Assistance Program (Division) pharmacy benefit manager, point of sale. For more information on point of sale, contact the DMAP pharmacy benefit manager's help desk;

(b) Only those pharmacies and Home Enteral/Parenteral Nutrition and IV (EPIV) providers billing manually for medications and home IV drug ingredients that are not billed through Point of Sale may use the CMS 1500 claim form or the 837P electronic claim form (instructions in home enteral/parenteral and IV services supplemental guide;

(c) Providers who bill by paper are required to complete a CMS 1500 claim form.

(2) For home enteral/parenteral and IV services other than medications:

(a) Providers must use the CMS 1500 form to bill for home enteral/parenteral nutrition and IV services identified with a five-digit HCPCS or CPT. Use the billing instructions found in the home enteral/parenteral nutrition and IV Services supplemental materials;

(b) See OAR 410-148-0160 for billing clients with Medicare coverage.

Notes

Or. Admin. R. 410-148-0140

HR 26-1990, f. 8-31-90, cert. ef. 9-1-90; HR 9-1992, f. & cert. ef. 4-1-92; OMAP 7-1998, f. 2-27-98, cert. ef. 3-1-98; OMAP 46-2001, f. 9-24-01, cert. ef. 10-1-01, Renumbered from 410-121-0740; OMAP 63-2003, f. 9-5-03, cert. ef. 10-1-03; DMAP 26-2008, f. 6-13-08, cert. ef. 7-1-08; DMAP 23-2009, f. 6-12-09, cert. ef. 7-1-09

Publications: Publications referenced are available from the agency.

Stat. Auth.: ORS 413.042

Stats. Implemented: ORS 414.065