MedicaidAdministrativeMedium impact
Claim formats for CCO-contracted Out-of-Hospital Birth services providers
Oregon Health Plan·OR · OB-GYN·Plan contract
Effective date
Feb 18, 2026
We identified it
Aug 19, 2026
Summary
Oregon Health Authority now allows CCO-contracted Out-of-Hospital Birth (OOHB) providers to submit claims using either professional (CMS-1500/837P) or institutional (UB-04/837I) claim formats. This change applies only to the three CCOs that have opted into the OOHB amendment and accommodates multi-day episodes of care (labor, delivery, postpartum observation) that cannot be accurately reported on professional claim forms alone.
Action Required
Immediately: If your practice is a CCO-contracted Out-of-Hospital Birth services provider in Oregon, contact your CCO to confirm whether they have signed the OOHB opt-in amendment. If yes, work with the CCO to verify which claim formats (professional CMS-1500/837P and/or institutional UB-04/837I) they accept. Update billing software and provider templates to support dual claim format submission capability for OOHB services. Ensure all OOHB claims submitted to the CCO use the appropriate format agreed upon. This guidance does NOT apply to OOHB services billed directly to OHA. Note that OAR Chapter 333, Division 77 discharge and transfer requirements (effective November 2025) continue to apply.