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

REQUIREMENTS: Immediately: Billing and eligibility teams must: 1. Update member eligibility verification processes in billing software to recognize the 12-month post-partum protected period for OHP members with pregnancy end dates on or after 4/1/2021 2. Train front-desk and billing staff to identify affected members using MMIS records, pregnancy end dates, and PERC codes 3. Verify member eligibility in MMIS Provider Portal to confirm supplemental benefits (BMP for ages 21+; BMH for under 21) are active for the full 12-month post-partum period Within 30 days: Billing team must: 1. Identify and compile all previously denied or patient-paid claims for covered services rendered during the post-partum period (on or after 4/1/2021) for affected members 2. Resubmit these claims to Oregon Health Plan for retroactive billing—providers have up to one year from the date coverage was restored (March 2, 2022 for most members) to bill for these services 3. Update billing documentation to note the ARPA Section 9812 protected post-partum coverage period Ongoing: Billing team must: 1. Monitor MMIS for ongoing changes—OHA is still adding BMP benefit lines to remaining records for members who turned 21 since their pregnancy ended and transitioning some members back to CHIP coverage 2. Ensure no coverage terminations occur during the 12-month post-partum period unless member dies, moves out of state, requests coverage end, or begins receiving SSI 3. Flag any claims for services rendered outside the pregnancy and 12-month post-partum window for manual review Consequences of inaction: Claims will be denied if eligibility is not correctly verified; revenue will be lost on retroactive claim opportunities (one-year window); member coverage may be incorrectly terminated, creating compliance and service delivery issues.