Update #2 regarding Planned Parenthood claims

IMMEDIATE ACTIONS REQUIRED: 1. By July 24, 2025 (TODAY): Billing team must implement claim processing rules in billing software to: - PAY all Planned Parenthood claims (PPCW and PPSO) with dates of service July 8-21, 2025, for CCO Medicaid members - HOLD (do not deny or pay) all Planned Parenthood claims with dates of service on or after July 22, 2025, for CCO Medicaid members, EXCEPT HOP members - CONTINUE PAYING Planned Parenthood claims for HOP members covered by Medicaid Contract (CHIP-funded) for all dates of service including July 4-7, 2025 - PROCESS AS NORMAL all Planned Parenthood claims for Non-Medicaid and OHP Bridge-BHP contract members regardless of date of service 2. Update claim routing logic: Verify member contract type (2025 CCO Medicaid vs. Non-Medicaid vs. OHP Bridge-BHP vs. HOP) before applying hold rules. This determination must be made at point of claim submission. 3. Staff training: Brief billing staff on the three claim categories and the hold/pay matrix. Emphasize that HOP members are an EXCEPTION to the hold requirement. 4. If claims were already paid for dates of service July 4-7, 2025 (non-HOP CCO Medicaid members): Do NOT submit encounter data to OHA, as OHA will direct claim reversal if data is submitted. 5. Monitor email from Medicaid.Programs@odhsoha.oregon.gov for further guidance as litigation continues. Be prepared to pay held claims retroactively if court rules in Planned Parenthood's favor. CONSEQUENCES: Paying held claims and submitting encounter data will result in OHA-directed claim reversals and possible contract compliance issues.