(a)Pharmacies billing electronically bill through the Division of Medical Assistance Program (Division) pharmacy benefit manager, point of sale. For more information on point of sale, contact the Division’s pharmacy benefit manager’s help desk;
(b)Only those pharmacies and Home Enteral/Parenteral Nutrition and IV (EPIV) providers billing manually for medications and home IV drug ingredients that are not billed through point of sale may use the CMS 1500 claim form or the 837P electronic claim form (instructions in home enteral/parenteral and IV services supplemental guide;
(c)Providers who bill by paper are required to complete a CMS 1500 claim form.
(2)For home enteral/parenteral and IV services other than medications:
(a)Providers must use the CMS 1500 form to bill for home enteral/parenteral nutrition and IV services identified with a five-digit Healthcare Common Procedure Coding System (HCPCS) or Current Procedural Terminology (CPT). Use the billing instructions found in the Home Enteral/Parenteral Nutrition and IV Services supplemental materials;
(b)See OAR 410-148-0160 (Billing for Clients Who Have Both Medicare and Basic Health Care Coverage) for billing clients with Medicare coverage.
Rule 410-148-0140 — Billing Information,