Updated: 12-month eligibility for Oregon Health Plan post-partum benefits

REQUIREMENTS: - Immediately: Billing team must verify all Oregon Health Plan member eligibility using pregnancy end dates in MMIS records to identify those eligible for 12-month post-partum benefits (pregnancies ending on or after April 1, 2021). Update internal eligibility verification processes to check for extended post-partum coverage status before billing. - By June 2022: Monitor OHA communications for member reimbursement process guidelines. Prepare to assist members with reimbursement claims for out-of-pocket expenses incurred during the retroactive benefit restoration period (March 2, 2022 and later). - Ongoing: Update provider communications and patient billing statements to reflect 12-month post-partum eligibility for OHP Plus members. Ensure claims are not denied for covered services during the 12-month post-partum period. - June 2022 and beyond: Monitor for capitation rate analysis results from Optumas. Be prepared for potential retroactive rate adjustments affecting the pregnant & postpartum rate group, which may impact claim reprocessing or refund reconciliation. - Note: Do NOT process denials for eligible services during the extended 12-month post-partum period. Failure to recognize this extended benefit will result in improper claim denials and member complaints.