Oregon Health Plan EDI Claims FAQs (Registration)

Oregon Health Plan EDI Claims – Registration Frequently Asked Questions

Oregon Health Plan EDI Claims initiative general information was given in the previous post. We have already mentioned the advantages of Oregon Health Plan EDI Claims program as well as the steps of establishing EDI partnership with the health plan company. Today we give you the first portion of frequently asked questions regarding Oregon Health Plan EDI Claims program. It is devoted to registration phase.

Oregon Health Plan EDI Claims Registration FAQs

1. How do I submit encounter data to Oregon Health Plan? – Sign up for EDI and follow encounter data submission guidelines.​
2. Can I list all providers on the first page of the TPA, or do I need to list each separately? – All Oregon Health Plan EDI Registration Numbers should have separate TPAs with associated National Provider Number (NPI), taxonomy code(s) and OHA EDI Registration number. The TPA is for the billing provider only. For example, if a clinic bills on behalf of its rendering providers, then only one TPA is required (for the clinic). ​
3. Does Oregon Health Plan accept COB claims? – Yes. Oregon Health Plan accepts, and process, properly formatted claims that have had prior payers.​
4. Which File Level Acknowledgement (typically 997 or 999 only) does Oregon Health Plan support? – X12 requires the “Implementation Acknowledgement for Health Care Insurance” (999) when an Acknowledgement is returned for 5010 version HIPAA transactions.
5. If I register for the 835 Remittance Advice (RA), can I still receive the paper RA? – Yes. There is a transition period where you will receive both the electronic Remittance Advice and the paper RA. This period allows you to verify that you can process the 835s you receive. Oregon Medicaid will continue to produce the paper RAs after a provider begins receiving the 835 remittance advice. You can ask us to stop sending you the paper RA at any time.
6. Does Oregon Health Plan have EDI software available? – No. Oregon Health Plan does not provide, or recommend, EDI software. Your current billing/practice management software may already be set up for EDI. Oregon Health Plan recommends contacting your business software team, your local professional association, or review the basic resources on EDI.

More FAQs in our next posts.

Learn more about Health Care EDI and HIPAA Compliance