Or. Admin. Code § 410-133-0220 - Billing

(1) The school medical provider must bill the Authority in compliance with OARs: 410-120-1280 and 943-120-0330.

(2) Charges on each claim must be at or lower than the education agency's reviewed and accepted cost for the same service.

(3) Services must be billed using a professional claim format (i.e., paper CMS-1500 or electronic equivalent to the CMS-1500 form).

(4) Timely filing: The Authority shall accept a claim up to twelve (12) months from the date of service. Once a service has been submitted on a claim within the 12-month timely filing limit, the school medical provider has an additional six (6) months to resubmit the denied claim or adjust the paid claim.

Notes

Or. Admin. Code § 410-133-0220

HR 39-1991, f. & cert. ef. 9-16-91; OMAP 31-2003, f. & cert. ef. 4-1-03; OMAP 31-2003, f. & cert. ef. 4-1-03; OMAP 53-2003, f. 8-13-03 cert. ef. 9-1-03; OMAP 24-2005(Temp), f. & cert. ef. 4-5-05 thru 10-1-05; OMAP 53-2005, f. 9-30-05, cert. ef. 10-1-05; DMAP 28-2008(Temp), f. 6-30-08, cert. ef. 7-1-08 thru 12-28-08; DMAP 32-2008(Temp), f. & cert. ef. 10-2-08 thru 3-27-09; DMAP 43-2008, f. 12-17-08, cert. ef. 12-28-08; DMAP 19-2009, f. 6-12-09, cert.ef. 7-1-09; DMAP 19-2020, temporary amend filed 04/09/2020, effective 04/09/2020 through 10/05/2020; DMAP 56-2020, amend filed 10/02/2020, effective 10/5/2020; DMAP 121-2024, amend filed 09/06/2024, effective 9/6/2024

Statutory/Other Authority: ORS 413.042 & 414.065

Statutes/Other Implemented: ORS 414.065