Or. Admin. R. 943-120-0320

Current through Register Vol. 63, No. 8, August 1, 2024

Section 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).

Or. Admin. R. 943-120-0320

OHA 14-2011(Temp), f. & cert. ef. 7-1-11 thru 12-27-11; OHA 20-2011, f. 8-30-11, cert. ef. 9-1-11; OHA 8-2012, f. 10-30-12, cert. ef. 11-1-12

Publications: Publications referenced are available from the agency.

Stat. Auth.: ORS 413.042

Stats. Implemented: ORS 414.065