MedicaidAdministrativeMedium impact
Inappropriate fee-for-service payments for some E&M codes and Medicare crossover claims
Oregon Health Plan·OR·Plan
We identified it
Jun 20, 2026
Summary
Oregon Health Authority is fixing a system error that caused inappropriate fee-for-service payments for some E&M codes that should have been billed to CCOs instead. Providers must verify member enrollment and rebill incorrectly submitted claims to the appropriate CCO.
Action Required
Immediately: Always verify member eligibility and enrollment on date of service to determine whether to bill OHA or CCO. If you incorrectly billed OHA for services that should go to member's CCO, void the OHA claim and rebill the CCO. For claims outside CCO's timely filing window, contact the CCO for assistance. For Medicare crossover claims, wait for OHA to resolve the system configuration issue.