OAR 333-010-0220
Provider Enrollment

(1)

An individual or organization that wishes to be an enrolling provider or an ancillary provider with the WW Program shall apply to the Center on a form prescribed by the Center.

(2)

In order to be eligible for enrollment, an individual or organization shall:

(a)

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; and

(b)

Meet applicable licensing or regulatory requirements set forth by federal and state statutes, regulations, and rules to be enrolled and to bill as a health care provider.

(3)

A laboratory or any other entity that does laboratory tests must provide evidence that it is CLIA certified in order to be a provider or an ancillary provider.

(4)

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

(5)

Upon receipt of an application the Center shall verify the information and determine if the individual or organization is eligible to be an enrolling or ancillary provider.

(6)

If the Center approves an application, an individual or organization shall:

(a)

Sign a medical services agreement that requires the provider to comply with these rules; and

(b)

Be issued a BCCP/WW Program agency number.

(7)

An enrolling or ancillary provider may not offer services to a client prior to receiving information from a Center WW Program representative about administering the WW Program.

(8)

An enrolling provider or ancillary provider shall notify the Center in writing within 30 days of the change if it changes its address, business affiliation, licensure, ownership, certification, billing agents, registered name, or Federal Tax Identification Number (TIN). Changes in business affiliation, ownership, registered name, and TIN may require the submission of a new application. Payments made to an enrolling provider or an ancillary provider who has not furnished such notification may be recovered by the Center.

(9)

An enrolling provider or an ancillary provider shall notify the Center in writing of a bankruptcy proceedings within 15 days.

(10)

An individual or organization outside the state of Oregon may be eligible for enrollment if the individual or organization:

(a)

Is appropriately licensed or certified in its state; and

(b)

Is located in a state contiguous to Oregon, and is within 75 miles of the Oregon border.

(11)

An enrolling provider or an ancillary provider may terminate enrollment at any time by sending a written termination notice to the Center, via certified mail, return receipt requested. The notice shall specify the agency number to be terminated and the effective date of termination. Termination of a provider enrollment does not terminate any obligations of the provider for services provided to a client prior to the effective date of the termination.

Source: Rule 333-010-0220 — Provider Enrollment, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=333-010-0220.

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 333-010-0220’s source at or​.us