MedicaidAdministrativeMedium impact
Ensuring member access to monoclonal antibody (mAb) treatment
Oregon Health Plan·OR · Infectious Disease, Emergency Medicine, Family Medicine +1 more·Plan
Effective date
Sep 22, 2021
We identified it
Jun 20, 2026
Summary
Oregon Health Authority implemented a 'no wrong door' policy allowing OHP-enrolled providers to bill OHA directly for monoclonal antibody (mAb) services if they cannot bill the member's CCO. This ensures COVID-19 treatment access for high-risk Oregon Health Plan members when presenting at any enrolled provider location.
Action Required
Immediately: Oregon providers should review current mAb access for CCO members and identify billing challenges. Billing teams must reference OHA's Oregon Medicaid COVID-19 Provider Guide for current coverage criteria, billing codes, and rates for mAb treatment. Implement ability to bill OHA directly when CCO billing is not possible for eligible high-risk members.