Update #5 regarding Planned Parenthood claims

REQUIREMENTS: Immediate (by September 24, 2025): Billing team must implement a two-date-range hold policy in the billing system for Planned Parenthood claims from Oregon Medicaid CCO members: 1. Process/Release: All Planned Parenthood claims with dates of service July 4, 2025 through September 10, 2025 — submit these claims normally without holds. 2. Hold/Suspend: All Planned Parenthood claims with dates of service September 11, 2025 and later — flag these claims in the billing system and DO NOT submit them for reimbursement. EXCEPTIONS: Continue processing claims normally for (1) HOP (Healthier Oregon Program) members covered by Medicaid Contract, (2) Non-Medicaid contract members, and (3) Oregon Health Plan Bridge – Basic Health Program contract members. ACTION STEPS: - Update billing software to automatically hold Planned Parenthood claims effective September 11, 2025 onward for standard Medicaid CCO members only - Configure system to flag these held claims separately for tracking and future reference - Audit any Planned Parenthood claims already submitted for dates on/after September 11, 2025 and recall/withdraw them from payer - Train billing staff on the two-phase process and plan type exceptions - Do NOT process these held claims until OHA issues further guidance (monitor Medicaid.Programs@odhsoha.oregon.gov) CONSEQUENCES: Failure to hold claims for dates on/after September 11, 2025 may result in claim denials and potential overpayment recovery demands from OHA. Processing errors on the cutoff dates will create reconciliation issues.