Current through Register Vol. 60, No. 12, December 1, 2021
regulations require Medicaid providers to maintain records that fully support
the extent of services for which payment has been requested, and that such
records be furnished to the Division upon request (
(2) When requested by the Division or its
medical review contractor, hospitals must submit sufficient medical
documentation to verify the emergency nature, medical necessity, quality and
appropriateness of treatment, and appropriateness of the length of stay for
inpatient and outpatient hospital services. The Division may request sufficient
information to evaluate the accuracy and appropriateness of ICD-10-CM Coding
for the claim. In addition, the Division may request an itemized billing for
all services provided. The Division will specify in its request what
documentation is required.
Or. Admin. R.
AFS 14-1980, f. 3-27-80,
ef. 4-1-80; AFS 60-1982, f. & ef. 7-1-82; AFS 46-1987, f. & ef.
10-1-87; AFS 49-1989(Temp), f. 8-24-89, cert. ef. 9-1-89; AFS 72-1989, f. &
cert. ef. 12-1-89, Renumbered from 461-015-0040; HR 21-1990, f. & cert. ef.
7-9-90, Renumbered from 461-015-0680;
51-2015, f. 9-22-15, cert. ef.
Stat. Auth.: ORS
Stats. Implemented: ORS