Or. Admin. Code § 410-129-0100

Current through Register Vol. 63, No. 12, December 1, 2024

Section 410-129-0100 - Medicare/Medicaid Claims

(1) When an individual not in managed care has both Medicare and Medicaid coverage, audiologists shall bill audiometry and all diagnostic testings to Medicare first. Medicare will automatically forward these claims to Medicaid. Refer to OAR 410-120-1210 (General Rules) for information on Division or CCO reimbursement.

(2) Audiologists shall bill all hearing aids and related services directly to the Division on an OHP 505. Payment authorization is required on most of these services.

(3) If Medicare transmits incorrect information to the Division, or if an out-of-state Medicare carrier or intermediary was billed, providers shall bill the Division using an OHP 505 form. If any payment is made by the Division, an adjustment request shall be submitted to correct payment, if necessary.

(4) Send all completed OHP 505 forms to the Division.

(5) Hearing aid dealers shall bill all services directly to the Division on a CMS-1500. Payment authorization is required on most services.

(6) When a client not in managed care has both Medicare and Medicaid coverage, speech-language pathologists shall bill services to Medicare first. Medicare will automatically forward these claims to Medicaid. Refer to OAR 410-120-1210 (General Rules) for information on Division or CCO reimbursement.

Or. Admin. Code § 410-129-0100

HR 5-1991, f. 1-18-91, cert. ef. 2-1-91; HR 11-1992, f. & cert. ef. 4-1-92; OMAP 36-1999, f. & cert. ef. 10-1-99; OMAP 12-2004, f. 3-11-04, cert. ef. 4-1-04; OMAP 57-2004, f. 9-10-04, cert. ef. 10-1-04; DMAP 49-2016, f. 7-26-16, cert. ef. 8/1/2016; DMAP 19-2017, f. & cert. ef. 6/9/2017

Stat. Auth.: ORS 413.042

Stats. Implemented: ORS 414.025, 414.034, 414.065, 414.329, 414.706 & 414.710