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Eligibility verification services
This page contains information on how Oregon Health Plan (OHP) providers can verify eligibility for DHS medical assistance clients. The General Rules provider guidelines include the Oregon Administrative Rule (OAR) that requires providers to verify eligibility before providing service.
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Resources
- Insurance Carrier Code List (revised 10/08) - If your eligibility verification resource only lists a 4-digit code for the client's third-party resource, refer to this list. It provides the carrier name and contact information for each carrier code.
- OHP Benefit Package and Copayment Chart (revised 12/08) - Refer to this chart for a quick reference of OHP covered services and copayment information.
- EEVS Frequently Asked Questions (revised 8/08) - DMAP’s contracts with current Electronic Eligibility Verification Service (EEVS) vendors ended Aug. 31, 2008. For more information, read this FAQ. If you have questions about the services your EEVS vendor provides, contact your vendor.
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Current eligibility verification options
The following options are available until the replacement MMIS goes live. For more information about the changes coming with the replacement MMIS, go to the MMIS Provider Resources Web site.
| Automated Information Systems (AIS) |
AIS may be accessed by Web or telephone free of charge. Services are available seven days a week.
- Web AIS: Click here to access the Web-based AIS Plus. For more information, see the AIS Plus user guide (PDF).
- Telephone AIS: Call 800-522-2508 to access the telephone AIS. For more information, see the AIS User Guide (PDF).
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| 270/271 Transaction |
Current Electronic Data Interchange (EDI) trading partners can request the ability to submit batch eligibility inquiries for DHS to verify within 24 hours using the 270/271 transaction.
If you currently bill through a clearinghouse, you may want to contact the clearinghouse to see if it will conduct the 270/271 transaction for you. This list of current DHS-registered clearinghouses (PDF) shows which clearinghouses provide 270/271 services. |
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Future eligibility verification options
The following options will be available when the replacement MMIS goes live. This comparison of eligibility verification options (PDF) can help you choose which of the following service(s) to use when verifying eligibility.
For more information about how to get ready for the replacement MMIS, go to the MMIS Provider Resources Web site.
| Provider Web Portal |
The Provider Web Portal will provide free, real-time eligibility verification over the Web. It will be available 24 hours a day, 7 days a week, excepting regularly scheduled down time on the weekend. The Web address for the Provider Web Portal will be https://www.or-medicaid.gov. |
| Automated Voice Response |
Automated Voice Response (AVR) is the free phone-based eligibility verification tool. The phone number will be 866-692-3864 (toll-free). |
| 270/271 Transaction |
If you want to become a DHS Trading Partner to exchange the 270/271 transaction, complete the EDI Registration Packet and submit it to DHS EDI Support Services. If approved, you will be set up to exchange the 270/271 in the replacement system once it goes live.
At go-live, the 271 response will not contain benefit package, copayment, or plan-specific enrollment information. If a client has any third-party resources (TPR), the 271 will indicate that TPR exists, but not what the specific resources are.
You will need to make sure that you obtain these pieces of information through the Web portal or AVR. |
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