Compensation and Billing
(1)All long term care community nursing services must be authorized by an individual’s case manager using Department approved forms provided by the Department prior to the delivery of long term care community nursing services.
(2)All billing and claims must comply with:
(a)OAR 407-120-0330 (Billing Procedures) and 407-120-0340 (Claim and PHP Encounter Submission);
(b)OAR chapter 410, division 120 as applicable; and
(c)The Long Term Care Nursing Procedure Codes and Payment Authorization Guidelines posted at http://www.oregon.gov/dhs/spd/pages/provtools/nursing/forms.aspx.
(3)Compensation for long term care community nursing services in OAR 411-048-0180 (Long Term Care Community Nursing Services) shall be defined in the Department’s rate schedule or through a contract with the Department. The Department may adjust rates in underserved areas to assure that individuals have access to long term care community nursing services.
(4)Payment for non-Medicaid covered services must be prior authorized by the Department and billed on Department approved invoices.
(a)Rates for non-Medicaid services shall be determined by the Department but may not exceed the rate noted on the Department’s rate schedule.
(b)The Department makes payment for non-Medicaid covered services within 45 days of receipt of the completed invoice.
Rule 411-048-0230 — Compensation and Billing,