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Medical payment recovery Frequently asked questions 1). Is Medicaid an Insurance company? No, we are a state agency that provides benefits for eligible clients under the Oregon Health Plan. If the client has private health insurance, and we have already paid the claims, we bill the third party for reimbursement.2). If I have questions concerning the information given to me on the ACIS system, who can I contact? You can call the Medical Payment Recovery unit @ (503) 947-4250. If they cant answer the question, they can direct you to the correct unit to assist you. 3). If I know that an Oregon Health plan client has a third party resource that does not show up on their medical card, who do I contact? Call (503) 378-2220 and ask to speak to someone in the Health Insurance group. 4). If my patient has the Oregon Health Plan, a third party resource, and/or is requesting services for a vehicle related injury or a work related injury, who do I contact? Personal Injury Liens handles vehicle related claims. (503) 378-4514 or 1-800-377-3841. Work related injuries are handled by Sheri Kliewer-Medical Payment Recovery (503) 947-4267. Or you can access the AFS451 NV forms directly at http://www.dhs.state.or.us/spd/tools/additional/generic/h.htm 5). How far back can a provider bill Medicare claims? You can contact Medicare directly at http://www.medicare.gov. 6). I have questions regarding the refund request I received. You can contact Medical Payment recovery @ 503-947-4250. Please specify if it is a medical claim or a prescription claim. 7). What is your fax #? (503) 391-2360 8). How much money do you recover/bill out? See Stats/Charts link on MPR page 9). How do I order HCFA 1500 forms? Through the CMS web site at http://www.cms.hhs.gov/providers/edi/edi5.asp#Form%20CMS-1500. 10). What does it mean when someone says Oregon is a "Pay and Chase" state? Pay and chase is utilized when the State Medicaid agency pays the medical bills and then attempts to recover from liable third parties. States are generally required to cost avoid claims unless they have a waiver approved by CMS which allows them to use the pay and chase method. For more information go to http://www.cms.hhs.gov/medicaid/tpl/default.asp. Please note that effective June 6, 2003 Oregon terminated their waiver for Pay and Chase and now utilize Cost Avoidance billing. 11). What is the difference between Pay and Chase and Cost Avoidance? Instead of Medicaid paying for client services first then billing the providers for reimbursement, providers must bill the third party insurance first, then bill Medicaid for the difference. |
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