New Medicaid Enrollment Requirement on Claims Submitted to CareOregon

Update as of 08/01/2017 – the Oregon Health Authority has implemented the attending provider enrollment requirement effective 08/01/2017. Please be advised that you may see an uptick in institutional claim denials for this reason effective immediately.

For Attending, Prescribing, Referring, First/Other Providers

Effective September 1, 2017, the Health Systems Division of the Oregon Health Authority will begin requiring that all attending, prescribing, referring, and first/other providers appearing on institutional and professional claim forms are enrolled with an Oregon Medicaid ID. This will impact any organization billing CareOregon with these provider types who have not yet been issued an Oregon Medicaid ID.

The denial reason on the remittance advice will read: 16: Claim/service lacks information which is needed for adjudication; 208: National Provider Identifier – Not Matched; Free form: Provider NPI must be enrolled with Oregon Medicaid.

There is a chance that OHA could push the effective date of this requirement further into the future. Check back here for updates.

If you would like to ensure all providers appearing on your submitted claims are enrolled, you can find a copy of our Oregon Medicaid ID Application form here.