MedicaidCoverageHigh impact
Provider Announcement
Oregon Health Plan·OR·Provider
Effective date
Feb 1, 2020
We identified it
Jun 20, 2026
Summary
Oregon Health Authority temporarily expanded CAWEM (Citizen-Alien Waived Emergency Medical) coverage to include all COVID-19 diagnosis and treatment services across all care settings (not just emergency rooms/hospitals), effective immediately. Providers must use specific billing modifiers (CR for professional claims, DR for institutional claims) and can backbill services from February 1, 2020 onward.
Action Required
Immediately: Billing team must update claim submission procedures to append modifier CR (Catastrophe/Disaster) on all professional claims and Condition Code DR (Disaster-Related) on all institutional claims for COVID-19-related services provided to CAWEM recipients. Update billing software to allow COVID-19 services to be billed from non-emergency settings (medical offices, urgent care). Train providers and billers to identify CAWEM-eligible patients receiving COVID-19 care. Contact Provider Services Unit at dmap.providerservices@dhsoha.state.or.us or 800-336-6016 (Option 5) with billing questions. Process retroactive claims for COVID-19 services dating back to February 1, 2020. Failure to apply correct modifiers will result in claim denials and payment delays.