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Self-service on the Web
One of the most exciting new features is the self-service Provider Web Portal, which will give providers and supporting staff the ability to:
- Submit and track the status of provider enrollment forms and attachments
- Perform online account maintenance
- Verify and view current recipient eligibility information
- Perform Prioritized List inquiries
- Request and view prior authorization requests
- Electronically submit, adjust and view individual claims online
In order to transition providers to this new system, DHS will implement Web portal functionality in phases between December 2008 and March 2009. More information about how to use the Provider Web Portal is at this link.
Phase 1 - December 2008
The following functions are now available:
| Online account administration |
For enrolled providers, logging onto the Provider Web Portal requires a unique ID and Personal Identification Number (PIN). During your first session on the Provider Web Portal, you will then setup your online account information and select a new PIN.
On the Provider Web Portal, providers can assign one or more staff-specific roles for accessing claims, PA, and eligibility verification screens on behalf of the provider. One clerk can be granted access to multiple providers. A group that bills for multiple providers can be created under one account. |
| Eligibility verification |
Providers will be able to verify and review eligibility on the Web, receiving such information as the client's benefit plans, third-party coverage, managed care assignments, lock-in information, and service limitations.
Providers will be able to search by client ID or a combination of Social Security Number (SSN) and birth date for specific dates of service. |
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Phase 2 - March 2009
The following functions will be available by March 2009:
| Provider enrollment |
Providers will be able to submit Web requests to enroll as a DHS provider. The online process gathers most of the data needed for enrollment. Providers can then fax or mail in additional information as needed.
The Enrollment Tracking Search feature then allows providers to track and check the status of their enrollment using a tracking number provided during the initial online application process.
Providers who enroll with DHS can start using the new process on paper today. Until the new system goes live, the DHS 3972 (Provider Enrollment Request) form will be used to capture basic enrollment information. Providers then need to complete the following forms:
For more information, go to the OHP Provider Enrollment page. |
| Prioritized List inquiries |
With the Prioritized List inquiry, providers will be able to verify if a specific client is covered for a specific service on the Oregon Health Plan according to diagnosis, service limitations, and real-time eligibility information. The client's copayment, managed care and other important eligibility information will be available, as well as specific Health Services Commission (HSC) guidelines for the diagnosis information entered by the provider.
This will give providers comprehensive and accurate service eligibility information for each client when checked on the date of service. |
| Prior Authorization (PA) |
Providers will be able to submit PA requests through the Provider Web Portal for selected non-emergency services authorized by DHS, including DME, home EPIV, home health, physical/occupational therapy, speech/hearing, and vision services.
- When providers submit their requests online, they will receive a PA number and immediate indication of PA status.
- Providers will also be able to search, review and track their PA requests online.
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| Online provider updates |
Online account administration includes the ability for many providers to update their business hours, location and other service information to make available to the public in an online provider directory. With this feature:
- Many providers will be able to update information such as office hours, location details, and availability on the Web.
- Providers who participate in the online directory then save clients the effort of calling their local provider offices to find out this information.
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| Online claims functionality |
Providers will be able to submit their claims by logging into the Provider Web Portal, where the providers will receive real-time responses indicating the claim paid, denied or suspended. In addition, all claims submitted (whether by EDI, paper or Web Portal) will be available online for tracking, review and resubmission as needed. |
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