Transcription of Oregon Health Plan Provider Web Portal
1 Oregon Health PlanProvider Web PortalEligibilityClient benefit plan, managed and coordinated care enrollment and fee-for-service (open card) informationJune 2017 Providers Page2 Click client dates of search3 Eligibility File4 Type Coverage and (Third Party Liability) LimitationsClient InformationYou will see service dates here if client has Medicare A, B or D5 There are seven basic benefit plans:Benefit PlanSystem codeBenefit planBMH OHP PlusBMPOHP Plus Supplemental (this code indicates pregnancy and may be seen along with another basic plan)BMDOHP with Limited DrugBMMQ ualified Medicare Beneficiary (QMB) and OHP with Limited DrugMEDQ ualified Medicare Beneficiary (QMB) CWMC itizen/Alien-Waived Emergency Medical (CAWEM)CWXP renatal Expansion for CAWEM clients6 CRN and SMHS are usually listed.
2 These and other system codes are for OHA Type Coverage7 Click a benefit plan row to see copayinformation listed by type of serviceClick here to see additional pagesTPLP opulates if client has private insurance; Always bill TPL first8 managed CarePlan codePlan TypeCCOC oordinated Care OrganizationFCHPF ully Capitated Health PlanPCMP rimary Care ManagerPCOP hysician Care OrganizationDCOD ental Care OrganizationMHOM ental Health Organization* Providers must contract with the plan to authorize and bill Populates if client is enrolled in managed or coordinated care;Check the Plan Type*9 PCM is listed under managed Care, but is not an MCO.
3 Services are not billed to the PCM, but you may need a referral from the PCM to provide some codePlan TypeCCOAP hysical, mental and dental healthCCOBP hysical and mental healthCCOEM ental Health onlyCCOGM ental and dental healthLockinPopulates if client is locked in to using a specific pharmacy10 Service LimitationsEnter a procedure code before clicking search to display service limitations11 RemindersSteps to verify a service is client eligibility on the date of service (benefit plans determine the level of coverage) the Prioritized List for procedure and diagnosis code pairing and the Fee-for-Service Fee Schedule (some codes may be covered according to the Prioritized List, but they may only be covered by a plan, not fee-for-service) http:// You Need Further Assistance?
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