Starting November 13, 2018, the Oregon Health Authority (OHA) will require that all pharmacy claims include the National Provider Identifier (NPI) of an OHA-enrolled prescriber.
This applies to:
Paper, point of sale, and Provider Web Portal claims billed to OHA, and
All pharmacy claims reported to OHA by coordinated care organizations (CCOs).
This means that any providers who write prescriptions for OHP members must enroll with OHA, including certified pharmacists who administer vaccines or prescribe birth control to members.
Why is this happening?
In late August, OHA received an unexpected volume of enrollment requests. Delaying the effective date of the prescriber enrollment requirement will allow OHA to process these requests, and any others, in advance of the change.
Federal Medicaid program integrity regulations and the Medicaid Provider Enrollment Compendium, Section 1.3) require all state Medicaid agencies to implement this requirement.
What should you do?
Enroll with OHA by October 31, 2018, if you are:
A physician or other professional who prescribes services for any OHP members, or
A certified pharmacist who administers vaccines or prescribes birth control to any OHP members.