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