Hospital services program
Oregon Administrative Rules
Chapter 410 Division 125 - Currently on file with Oregon Secretary of State
Recent rule revisions
- 04/04/2014 (P) - Elimination of Oregon Health Plan Standard Benefit Plan Effective January 1, 2014
- 01/01/2014 (T) - 410-125-0020, 410-125-0080, 410-125-0085, 410-125-0047 - Elimination of OHP Standard benefit plan effective January 1, 2014
- 08/29/2013 (P) - 410-125-0450 - Revise Health Care-Acquired Conditions policy to include Critical Access Hospitals
Hospital Services Provider Guide - Updated 9/1/12
National Drug Code (NDC) Billing Tips - This document explains how to enter NDC information on medical and institutional outpatient claims for codes that require NDC reporting (e.g., physician-administered drugs). Also see DMAP's frequently asked questions about NDC requirements (link).
Hospital Presumptive Eligibility - Forms, resources and other information
Ambulatory Payment Classification (APC) resources
Standard Population Limited Hospital Benefit Code Lists
Effective Jan. 1, 2012, OHP Standard hospital benefits are the same as OHP Plus hospital benefits.
EDMS Coversheet - Use this form whenever you fax documentation for prior authorization requests, provider enrollment requests, or claims to DMAP.
Oregon Pharmacy and Oral Nutritional Supplement PA Request - When requesting prior authorization for drugs or oral nutritional supplements dispensed to OHP clients on a fee-for-service basis, fax this form to the Oregon Pharmacy Call Center at 888-346-0178.
Inpatient Hospital Hold Request for OHP Application - Submit this form once daily via secure email to firstname.lastname@example.org.
Newborn Notification Form - To receive prompt payment for delivery services covered by DMAP, notify the OHA Statewide Medical Processing Center when you deliver newborns for OHP clients.
Diagnostic Related Group (DRG) Weights
Medicare weights - Version 31, effective Oct. 1, 2013; Version 30, effective Oct. 1, 2012; Version 29, effective Oct. 1, 2011; Version 28, effective Oct. 1, 2010; Version 27, effective Oct. 1, 2009 - Older DRG Weights (zip file)
Oregon unique weights - Effective Oct. 1, 2007
Find the clinical lab fee schedule in DMAP's fee-for-service fee schedule.
Child and Adolescent Psychiatric Services Rates by Contracted Hospital -Effective 8/1/08
DMAP only posts the following rates for the current and previous year. For earlier rates, contact DMAP.
Who to call for help