Denied Claims
How to resolve denied claims depends on the reason for the denial.
Correct and resubmit the claim. You cannot void or adjust a denied claim.
Send a letter stating reasons for the appeal or redetermination. Do this within 180 days of the denial.
- Attach the claim for denied services.
- Attach the original denial notice or remittance advice (RA).
- Include complete documentation that supports covering the service. See Oregon Administrative Rule (OAR) 410-120-1570 to learn more about the types of information to send.
Mail to OHP Provider Services:
500 Summer St NE, E44
Salem, OR 97301
Overpaid or Underpaid Claims
You can void or adjust the claim. If you do this, no further action is needed to adjust prior payments. Payment adjustments will automatically show in future remittance advices (RAs).
If it has been less than one year since the claim's date of service, you can use the MMIS Provider Portal to:
- Void the claim or
- Adjust the claim to add any other payment information that may cause the claim to pay differently.
If you use an Electronic Data Interchange (EDI) clearinghouse to submit claims, you can void or adjust using your EDI software.
For older claims, you can submit the OHP 1036 form. On the form, you can:
- Request to void the claim or
- List the specific changes needed to adjust the claim.
When to Send a Check
If you cannot void or adjust an overpaid claim, you can send a check made out to “Oregon Medicaid." It can take up to four months to process your check and have the refund show up on your RA.
Include a letter stating what the check is for.
- List the Internal Control Number for each claim.
- If the check is for more than one claim, list how much money goes to each claim.
Attach a copy of the original RA.
Mail the check, letter and RA copy to:
ODHS/OHA Receipting
500 Summer St NE, 4th Floor
Salem OR 97301