Or. Admin. Code § 943-120-0320 - Provider Enrollment
(1) In some Authority program
areas, being an enrolled Authority provider is a condition of
eligibility for an Authority contract for certain services or
activities. Billing providers must be enrolled with the Authority as
providers consistent with the provider enrollment processes set forth
in OAR 410-120-0310 through 0350 and 410-120-1260. If reimbursement
for covered services is made under a contract with the Authority, the
provider must also meet the Authority's contract requirements.
Contract requirements are separate from the requirements of these
rules. Enrollment as a provider with the Authority is not a promise
that the enrolled provider shall receive any amount of work from the
Authority, a CCO, PHP, or a county.
(2) Provider enrollment establishes
essential Authority provider participation requirements for becoming
an enrolled Authority provider. The details of provider qualification
requirements, client eligibility, covered services, how to obtain
prior authorization or review, if required, documentation
requirements, claims submission, and available electronic access
instructions, and other instructions and requirements are contained
in Authority program-specific rules in chapter 410 or
contract.
(3) Prior to
enrollment, providers must:
(a)
Meet all program-specific or contract requirements identified in
program-specific rules or contracts and the requirements set forth in
these rules and OAR 410-120-1260;
(b) Meet Authority contracting
requirements, as specified by the Authority's Office of Contracts and
Procurement (OC&P);
(c) Meet Authority and federal
licensing and certification requirements for the type of service for
which the provider is enrolling; and
(d) Obtain a provider number from
the Authority subject to OAR 410-120-1260.
(4) A provider may request to
conduct electronic transactions with the Authority by enrolling and
completing the appropriate authorization forms pursuant to the
electronic data transaction rules (OAR 943-120-0100 to
943-120-0200).
Notes
Publications: Publications referenced are available from the agency.
Stat. Auth.: ORS 413.042
Stats. Implemented: ORS 414.065
State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.
No prior version found.