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Rending provider required on all behavioral health claims, including residential services, effective March 1, 2016

January 26, 2016

The Oregon Health Authority has recently announced that effective March 1, 2016, all claims for behavioral health (mental health and substance use disorder) services submitted must include a DMAP-enrolled rendering provider. In light of this regulatory change, CareOregon will remove functionality currently in place that enables claims submitted by behavioral health service providers to process without a rendering provider listed effective March 1, 2016.

Any claims submitted for dates of service after February 29, 2016 without a valid individual rendering provider included will be paid at $0 with remit code 185 (The rendering provider is not eligible to perform the service billed). This remit will be used because the billing provider NPI will no longer be a valid rendering provider and will no longer be eligible to be reimbursed for services.

For more information about this important change, please reference the memo from the OHA.