OAR 410-120-1300
Timely Submission of Claims

(1) In order to be reimbursed for services rendered, providers must comply with the following:
(a) Medicaid fee-for-service only claims must be filed within 12 months of the date of service. The date of service for an inpatient hospital stay is considered the date of discharge;
(b) Claims for recipients that have Medicare and Medicaid coverage must be filed with the Medicare fiscal intermediary within 12 months of the date of service to meet the Division’s timely filing rule;
(c) Claims that fail to cross over electronically from Medicare must be submitted hard copy to the Division within six months from the date on the Medicare Explanation of Medicare Benefits (EOMB), provided they are filed with Medicare within one year from the date of service;
(d) Claims for CCO enrolled members must comply with Oregon Administrative Rule 410-141-3420.
(2) A claim submitted within 12 months of the date of service but is denied may be resubmitted within 18 months of the date of service. These claims must be submitted to the Health Systems Division (Division) at the address listed in the provider contacts document. The provider must present documentation acceptable to the Division verifying the claim was originally submitted within 12 months of the date of service, unless otherwise stated in individual provider rules. Acceptable documentation is:
(a) A remittance advice from the Division that shows the claim was submitted before the claim was one year old;
(b) A copy of a billing record or ledger showing dates of submission to the Division.
(3) Exceptions to the 12-month requirement that may be submitted to the Division are as follows:
(a) When the Department, Division, or the client’s branch office makes an error that causes the provider not to be able to bill within 12 months of the date of service, the claim may be filed up to six months after the error is discovered. The Division must confirm the error;
(b) When a court or an Administrative Law Judge orders the Division to make payment;
(c) When the Division determines a client is retroactively eligible for Division medical coverage and more than 12 months passes between the date of service and the determination of the client’s eligibility.

Source: Rule 410-120-1300 — Timely Submission of Claims, https://secure.­sos.­state.­or.­us/oard/view.­action?ruleNumber=410-120-1300.

410‑120‑0000
Acronyms and Definitions 410‑120‑0003
OHP Standard Benefit Package 410‑120‑0006
Medical Eligibility Standards 410‑120‑0011
Effect of COVID-19 Emergency Authorities on Administrative Rules 410‑120‑0025
Administration of Division of Medical Assistance Programs, Regulation and Rule Precedence 410‑120‑0030
Children’s Health Insurance Program 410‑120‑0035
Public Entity 410‑120‑0045
Applications for Medical Assistance at Provider locations 410‑120‑0250
Managed Care Entity 410‑120‑1140
Verification of Eligibility and Coverage 410‑120‑1160
Medical Assistance Benefits and Provider Rules 410‑120‑1180
Medical Assistance Benefits: Out-of-State Services 410‑120‑1190
Medically Needy Benefit Program 410‑120‑1195
SB 5548 Population 410‑120‑1200
Excluded Services and Limitations 410‑120‑1210
Medical Assistance Benefit Packages and Delivery System 410‑120‑1260
Provider Enrollment 410‑120‑1280
Billing 410‑120‑1285
Recoupment and Data Sharing with Third-Party Insurers 410‑120‑1295
Non-Participating Provider 410‑120‑1300
Timely Submission of Claims 410‑120‑1320
Authorization of Payment 410‑120‑1340
Payment 410‑120‑1350
Buying-Up 410‑120‑1360
Requirements for Financial, Clinical and Other Records 410‑120‑1380
Compliance with Federal and State Statutes 410‑120‑1385
Compliance with Public Meetings Law 410‑120‑1390
Premium Sponsorships 410‑120‑1395
Program Integrity 410‑120‑1396
Provider and Contractor Audits 410‑120‑1397
Recovery of Overpayments to Providers — Recoupments and Refunds 410‑120‑1400
Provider Sanctions 410‑120‑1460
Type and Conditions of Sanction 410‑120‑1510
Fraud and Abuse 410‑120‑1560
Provider Appeals 410‑120‑1570
Claim Re-Determinations 410‑120‑1580
Provider Appeals — Administrative Review 410‑120‑1600
Provider Appeals — Contested Case Hearings 410‑120‑1855
Client’s Rights and Responsibilities 410‑120‑1860
Contested Case Hearing Procedures 410‑120‑1865
Denial, Reduction, or Termination of Services 410‑120‑1870
Client Premium Payments 410‑120‑1875
Agency Hearing Representatives 410‑120‑1880
Contracted Services 410‑120‑1920
Institutional Reimbursement Changes 410‑120‑1940
Interest Payments on Overdue Claims 410‑120‑1960
Payment of Private Insurance Premiums 410‑120‑1980
Requests for Information and Public Records 410‑120‑1990
Telehealth
Last Updated

Jun. 8, 2021

Rule 410-120-1300’s source at or​.us