OAR 333-010-0135
Provider Enrollment

(1)

This rule applies only to providers participating in ScreenWise BCC through an approved provider agreement with the Center.

(2)

An individual or organization must meet applicable licensing or regulatory requirements set forth by federal and state statutes, regulations, and rules to be enrolled and to bill as a provider. In addition, all providers of services within the State of Oregon must have a valid Oregon business license if such a license is a requirement of the state, federal, county or city government to operate a business or to provide services.

(3)

An individual or organization that is currently subject to sanctions by the Authority or the federal government is not eligible for enrollment.

(4)

A ScreenWise BCC agency number will be issued to an individual or clinic upon:

(a)

Completion of the application and submission of the required documents;

(b)

The signing of the provider agreement by the provider or person authorized by the provider to bind the organization or individual to comply with these rules;

(c)

Verification of licensing or certification; and

(d)

Approval of the application by the Center.

(5)

Issuance of an agency number establishes enrollment of an individual or organization as a provider for ScreenWise BCC services.

(6)

If a provider changes address, business affiliation, licensure, ownership, certification, billing agents, registered name, or Federal Tax Identification Number (TIN), the Center must be notified in writing within 30 days of the change. Failure to notify the Center of a change of TIN may result in the imposing of a fine. Changes in business affiliation, ownership, registered name, and TIN may require the submission of a new application. Payments made to providers who have not furnished such notification may be recovered.

(7)

Providers of services outside the state of Oregon will be enrolled under the following conditions:

(a)

The provider is appropriately licensed or certified by the provider’s state;

(b)

The provider lives in a state contiguous to Oregon, and is within seventy-five miles of the Oregon border.

(8)

Provider termination:

(a)

The provider may terminate enrollment at any time. The request must be sent to the Center in writing, via certified mail, return receipt requested. The notice shall specify the agency number to be terminated and the effective date of termination. Termination of the provider enrollment does not terminate any obligations of the provider for dates of services during which the enrollment was in effect.

(b)

ScreenWise BCC provider terminations or suspensions and subsequent recovery of any payments made by the Center may be for, but are not limited to, the following reasons:

(A)

Breaches of the medical services agreement;

(B)

Failure to comply with the statutes, regulations and policies of the Authority, and federal or state regulations that are applicable to the provider;

(C)

Loss of the appropriate licensure or certification.

(9)

The provider is entitled to a contested case hearing to determine whether the provider’s agency number will be revoked.

(10)

In the event of bankruptcy proceedings, the provider must notify the Center in writing within 15 days.

(11)

Providers must receive information about administering the ScreenWise BCC from a ScreenWise BCC representative before services are initiated.

Source: Rule 333-010-0135 — Provider Enrollment, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=333-010-0135.

333–010–0000
Cancer Reporting Regulations: Definitions 333–010–0020
Cancer Reporting Regulations: Reporting Requirements for Health Care Facilities 333–010–0030
Cancer Reporting Regulations: Reporting Requirements for Practitioners 333–010–0032
Cancer Reporting Regulations: Reporting Requirements for Clinical Laboratories 333–010–0035
Cancer Reporting Regulations: Patient Notification Requirement 333–010–0040
Cancer Reporting Regulations: Quality Standards 333–010–0050
Cancer Reporting Regulations: Confidentiality and Access to Data 333–010–0055
Cancer Reporting Regulations: Research Studies 333–010–0060
Cancer Reporting Regulations: Special Studies 333–010–0070
Cancer Reporting Regulations: Advisory Committee 333–010–0080
Cancer Reporting Regulations: Training and Consultation 333–010–0090
Cancer Reporting Regulations: Fees 333–010–0100
ScreenWise Breast and Cervical Cancer Program: Description of the ScreenWise Breast and Cervical Cancer Program 333–010–0105
Definitions 333–010–0110
Client Eligibility 333–010–0115
Client Enrollment 333–010–0120
Covered Services 333–010–0125
Excluded Services 333–010–0130
Standards of Care for Breast and Cervical Cancer Screening and Diagnostic Services 333–010–0135
Provider Enrollment 333–010–0140
Billing 333–010–0145
Claims and Data Submission 333–010–0150
Timely Submission of Claims and Data 333–010–0155
Payment 333–010–0160
Requirements for Financial, Clinical and Other Records 333–010–0165
Compliance with Federal and State Statutes 333–010–0170
Denial or Recovery of Reimbursement Resulting from Review or Audit 333–010–0175
Recovery of Overpayments to Providers Resulting from Review or Audit 333–010–0180
Provider Sanctions 333–010–0185
Provider Appeals 333–010–0190
Provider Appeals (Level 1) — Claims Reconsideration 333–010–0195
Provider Appeals (Level 2) — Contested Case Hearing 333–010–0197
Presumptive Eligibility for BCCTP 333–010–0200
ScreenWise WISEWOMAN Program: Description of the WISEWOMAN Program 333–010–0205
Definitions 333–010–0210
Client Eligibility 333–010–0215
Client Enrollment 333–010–0220
Provider Enrollment 333–010–0225
Standards of Care for WISEWOMAN Program Screening and Services 333–010–0230
Submission of Information by Ancillary Providers 333–010–0235
Covered Services 333–010–0240
Excluded Services 333–010–0245
Claims and Billing 333–010–0250
Payment 333–010–0255
Denial or Recovery of Reimbursement Resulting from Review or Audit 333–010–0260
Recovery of Overpayments to Providers Resulting from Review or Audit 333–010–0265
Client Data Submission 333–010–0270
Requirements for Financial, Clinical and Other Records 333–010–0275
Compliance with Federal and State Statutes 333–010–0280
Provider Sanctions 333–010–0285
Provider Appeals (Level 1) — Claims Reconsideration 333–010–0290
Provider Appeals (Level 2) — Contested Case Hearing 333–010–0300
Tobacco Prevention and Education Program: Definitions 333–010–0310
Tobacco Prevention and Education Program: Purpose and Intent 333–010–0320
Tobacco Prevention and Education Program: Framework for Grant Awards 333–010–0330
Tobacco Prevention and Education Program: Local Coalitions and Community-Based Programs 333–010–0350
Tobacco Prevention and Education Program: Statewide Public Awareness and Education Programs 333–010–0360
Tobacco Prevention and Education Program: Statewide and Regional Projects Programs 333–010–0370
Tobacco Prevention and Education Program: Reporting 333–010–0600
Childhood Diabetes Database: Definitions 333–010–0610
Childhood Diabetes Database: General Authority and Purpose 333–010–0620
Childhood Diabetes Database: Reporting Requirements for Schools 333–010–0630
Childhood Diabetes Database: Reporting Requirements for Practitioners 333–010–0640
Childhood Diabetes Database: Confidentiality and Access to Data 333–010–0650
Childhood Diabetes Database: Research Studies 333–010–0660
Childhood Diabetes Database: Advisory Committee 333–010–0700
Dental Pilot Projects: Purpose 333–010–0710
Dental Pilot Projects: Definitions 333–010–0720
Dental Pilot Projects: Application Procedure 333–010–0730
Dental Pilot Projects: Application Review Process 333–010–0740
Dental Pilot Projects: Project Application Provisional Approval or Denial 333–010–0750
Dental Pilot Projects: Provisional Approval 333–010–0760
Dental Pilot Projects: Minimum Standards 333–010–0770
Dental Pilot Projects: Informed Consent 333–010–0780
Dental Pilot Projects: Pilot Project Evaluation and Monitoring by Sponsor 333–010–0790
Dental Pilot Projects: Authority Responsibilities 333–010–0800
Dental Pilot Projects: Project Modifications 333–010–0810
Dental Pilot Projects: Discontinuation or Completion of Project 333–010–0820
Dental Pilot Projects: Suspension, Denial or Termination of Project
Last Updated

Jun. 8, 2021

Rule 333-010-0135’s source at or​.us