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New DMAP ID Requirement for Medicaid Chemical Dependency and Mental Health Rendering Providers

September 03, 2015

CareOregon has a revised process for providers billing for Medicaid chemical dependency services. Effective October 15, 2015, providers billing CareOregon for Medicaid chemical dependency and mental health services must include a DMAP-enrolled rendering provider on all submitted 1500 claim forms.

CareOregon has a single provider database supporting claims processing for both Medicare and Medicaid services. Historically, we have not encountered rendering providers listed on 1500 claims when providers were billing Medicaid mental health and chemical dependency services. DMAP does not require – but does allow – rendering providers to be listed on these claims. We processed and encountered these claims under the billing organization as is allowed by DMAP.

We are making this billing change in order to accommodate the Medicare requirement that rendering providers be listed on mental health claims. We are also making this change to address claim delays and denials that have resulted from our single database managing the differing rules. We understand that this change represents a shift in how Medicaid chemical dependency claims are processed in that previously unenrolled providers will now require an active DMAP ID. Please review the CareOregon Provider Manual for information on establishing and maintaining DMAP provider IDs for rendering providers.

If you have questions about this change, please call Amy Barnwell, Provider Configuration and Encounter Data Supervisor at 503-416-5753.