Or. Admin. Code § 407-120-0112
Current through Register Vol. 63, No. 11, November 1, 2024
Section 407-120-0112 - Scope and Sequence of Electronic Data Transmission Rules(1) The Department communicates with and receives communications from its providers, PHPs, and allied agencies using a variety of methods appropriate to the services being provided, the nature of the entity providing the services, and constantly changing technology. These rules describe some of the basic ways that the Department will exchange data electronically. Additional details may be provided in the Department's access control rules, provider-specific rules, or the applicable contract documents.(2) Access to eligibility information about covered individuals may occur using one or more of the following methods: (a) Automated voice response, via a telephone;(c) EDI submitter access; or(d) Point of sale (POS) for pharmacy providers.(3) Claims for which the Department is responsible for payment or encounter submissions made to the Department may occur using one or more of the following methods: (a) Paper, using the form specified in the provider specific rules and supplemental billing guidance. Providers may submit paper claims, except that pharmacy providers are required to use the POS process for claims submission and PHPs are required to use the 837 electronic formats;(c) EDI submitter access; or(d) POS for pharmacy providers.(4) Department informational updates, provider record updates, depository for PHP reports, or EDT as specified by the Department for contract compliance.(5) Other Department network and information system access is governed by specific program requirements, which may include but is not limited to IUP access. Affected providers, PHPs, and allied agencies will be separately instructed about the access and requirements. Incidents are subject to these rules.(6) Providers and allied agencies that continue to use only paper formats for claims transactions are only subject to the confidentiality and security rule, OAR 407-120-0170.Or. Admin. Code § 407-120-0112
DHSD 13-2007(Temp), f. 12-31-07, cert. ef. 1-1-08 thru 6-28-08; DHSD 1-2008, f. & cert. ef. 2-1-08; DHSD 5-2011(Temp), f. & cert. ef. 7-1-11 thru 12-27-11; DHSD 13-2011, f. & cert. ef. 12-27-11Stat. Auth.: ORS 409.050 & 414.065
Stats. Implemented: ORS 414.065