MedicaidReimbursementHigh impact
Provider billing and member reimbursement for retroactive OHP Supplemental benefits
Oregon Health Plan·OR · Dentistry, Optometry·Provider
Effective date
Jul 28, 2022
We identified it
Jun 20, 2026
Summary
Oregon Health Plan dental and vision providers must bill CCOs/DCOs for services retroactively covered under extended 12-month postpartum benefits and refund members who previously paid out-of-pocket. Specific billing deadlines apply: by November 30, 2022 for services June-November 2021, and within 365 days for services after December 1, 2021.
Action Required
By November 30, 2022: Billing team must identify OHP members who paid out-of-pocket for dental/vision services during retroactive eligibility periods (June 2021-November 2021). Verify eligibility, obtain service authorization, and bill appropriate CCO/DCO/OHA. Issue full refunds to members even if member payment exceeds reimbursement amount. For services after December 1, 2021, bill within 365 days of service date.