PH TECH is proud to serve, and partner with our community-based health plans whose goal is to achieve a better state of health for those most underserved. Healthcare providers are an important part of this mission. We intend to create efficiencies for providers and billing agents in submitting claims for payment and not place any unnecessary processing barriers in the way. There are restrictions though, set by the Federal Government to ensure payment integrity and the safety of patients. Described below are potential outcomes for claims we receive that we are unable to process due to enrollment and screening requirements.
Please select the appropriate item affecting outcome:
Medicaid Enrollment (CARC 185, RARC N767)
Federal law (CFR 455.410) requires all providers and billing agents receiving federal payments to be enrolled with the State Medicaid agency - Oregon Health Authority (OHA).
To be eligible to enroll, practitioners in Oregon must have an NPI (National Provider Identifier), be licensed, and currently registered by the appropriate state agency. Out-of-state practitioners must have an NPI, be licensed, and currently registered by the appropriate agency in their state. Other providers must be approved, have an NPI, be licensed/issued a permit, and certified by the appropriate state agency(or if applicable certified under Medicare).
We want to assist you in enrolling! Please complete an enrollment application found below, and supply any required supporting documentation. All providers, even those who are not billing OHP Medicaid but provide services to beneficiaries are required to enroll. Applications are screened based on Federal and State guidelines prior to an enrollment decision (CFR 455.450). Please retain copies of your application materials for your records. You will receive a response upon approval or denial of your enrollment with OHP Medicaid.
Please Select A Health Plan
If you do not see the plan name that you are trying to bill listed below, please call 503-315-4130 from 8am to 5pm Monday through Friday for additional assistance.
Please follow the link below to submit your enrollment request:
If you are submitting a billing/ownership enrollment request, please fill out the Provider Disclosure Statement of Ownership OHA 3974 and date/sign by hand (for FAQ regarding the OHA 3974 click here) and attach along with your request at the link below:
*NOTE: If you submitted your claim and it denied CARC 185 for non-enrollment, please refrain from rebilling the same claim. All affected claims on file will be auto-reprocessed.
If you have enrollment related questions please feel free to call 503-315-4130 Monday through Friday 8AM to 5PM.
The instructions and form are available at the link below.
Please complete the attached form with all necessary information and return it along with your most recent signed and dated W9. This information can be mailed to:
Coos Health & Wellness Attn: Debbie Reed Administrative Services Manager
281 LaClair Street
Coos Bay, OR 97420
You may also fax this information to: 541-888-8726, Attn: Debbie Reed. If you have any questions, please feel free to contact us at 541-266-6762. After you have returned the form, please resubmit your claim so that it may be processed correctly.
The instructions and form are available at the link below.
Please complete the attached form with all necessary information and return it along with your most recent signed and dated W9. Please also resubmit your claim so it can be processed correctly. This information can be mailed to:
GOBHI or EOCCO Attn: Kathy Gould 401 E 3rd St. Ste. 101
The Dalles, OR 97058
You may also fax this information to: (541) 298-7996, Attn: Provider Enrollment.
Please follow the link below to submit your enrollment request:
If you are submitting a billing/ownership enrollment request, please fill out the Provider Disclosure Statement of Ownership OHA 3974 and date/sign by hand (for FAQ regarding the OHA 3974 click here) and attach along with your request at the link below:
*NOTE: If you submitted your claim and it denied CARC 185 for non-enrollment, please refrain from rebilling the same claim. All affected claims on file will be auto-reprocessed.
If you have enrollment related questions please feel free to call 503-315-4130 Monday through Friday 8AM to 5PM.
Please follow the link below to submit your enrollment request:
If you are submitting a billing/ownership enrollment request, please fill out the Provider Disclosure Statement of Ownership OHA 3974 and date/sign by hand (for FAQ regarding the OHA 3974 click here) and attach along with your request at the link below:
*NOTE: If you submitted your claim and it denied CARC 185 for non-enrollment, please refrain from rebilling the same claim. All affected claims on file will be auto-reprocessed.
If you have enrollment related questions please feel free to call 503-315-4130 Monday through Friday 8AM to 5PM.
The instructions and form are available at the link below.
Please complete the attached form with all necessary information and return it along with your most recent signed and dated W9. Please also resubmit your claim so it can be processed correctly. This information can be mailed to:
Primary Health of Josephine County 1867 Williams Hwy, Suite 108
Grants Pass, OR 97527
You may also fax this information to: (541) 471-4898, Attn: Claims.
Please follow the link below to submit your enrollment request:
If you are submitting a billing/ownership enrollment request, please fill out the Provider Disclosure Statement of Ownership OHA 3974 and date/sign by hand (for FAQ regarding the OHA 3974 click here) and attach along with your request at the link below:
*NOTE: If you submitted your claim and it denied CARC 185 for non-enrollment, please refrain from rebilling the same claim. All affected claims on file will be auto-reprocessed.
If you have enrollment related questions please feel free to call 503-315-4130 Monday through Friday 8AM to 5PM.
Please follow the link below to submit your enrollment request:
If you are submitting a billing/ownership enrollment request, please fill out the Provider Disclosure Statement of Ownership OHA 3974 and date/sign by hand (for FAQ regarding the OHA 3974 click here) and attach along with your request at the link below:
*NOTE: If you submitted your claim and it denied CARC 185 for non-enrollment, please refrain from rebilling the same claim. All affected claims on file will be auto-reprocessed.
If you have enrollment related questions please feel free to call 503-315-4130 Monday through Friday 8AM to 5PM.
Exclusion List (CARC B7)
Federal law (CFR 455.450) requires all providers and billing agents to be screened before being enrolled (and monthly after that) with any health care plan funded directly or indirectly by the U.S. Government. This includes any programs that provide health benefits such as Medicaid and Medicare. The screening process includes federal data base checks and license verification.
If a provider or billing agent submits a claim to PH TECH and is found to be excluded from participation and therefore ineligible of being reimbursed, the provider or billing agent will receive a remittance advice with the following information for the submitted claim(s):
CARC B7
This provider was not certified/eligible to be paid for this procedure/service on this date of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
License Expiration (CARC B7, RARC M143)
Federal law (CFR 455.450) requires all providers and billing agents to be screened before being enrolled (and monthly after that) with any health care plan funded directly or indirectly by the U.S. Government. This includes any programs that provide health benefits such as Medicaid and Medicare. The screening process includes federal data base checks and license verification.
If a provider or billing agent submits a claim to PH TECH and either the rendering, ordering, or referring provider’s license or certification is found to be expired, the provider or billing agent will receive a remittance advice with the following information for the submitted claim(s):
CARC B7
This provider was not certified/eligible to be paid for this procedure/service on this date of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
RARC M143
The provider must update license information with the payer.
