MedicaidAdministrativeMedium impact
Provider Announcement
Oregon Health Plan·OR · Pharmacy·Provider
Effective date
Apr 17, 2020
We identified it
Jun 20, 2026
Summary
Oregon Health Authority is allowing OHP pharmacies to temporarily override specific prescription denials during the COVID-19 emergency using Other Coverage Code (OCC) 1 for incorrect third-party liability (TPL) issues and calling for overrides when prescribers are not yet enrolled. This is a temporary emergency measure to ensure patient access to fee-for-service prescriptions.
Action Required
Effective immediately through end of COVID-19 emergency: (1) Pharmacy staff must implement OCC 1 override process for OHP fee-for-service prescriptions when TPL coverage on file is confirmed incorrect by member—only after confirming member no longer has primary insurance and encouraging TPL reporting at www.ReportTPL.org. Do not fill if member still has TPL and primary payer requires prior auth. (2) Pharmacy staff must call Oregon Pharmacy Call Center at 1-888-202-2126 to request temporary overrides when prescriber has not yet enrolled with OHA; direct non-enrolled prescribers to complete OHP 3113 form and fax to OHA at 503-378-3074. (3) Billing team must document all overrides used and maintain records for audit purposes. Failure to follow TPL verification requirements will result in inappropriate claim denials and potential member access delays.