 |
|
|
Provider and plan FAQs: Access to care
Other delivery system FAQs: OHP Benefit Packages • Access • Premiums • Copayments
Are these clinics required to charge our members a copayment? Q. Can our members seek services from a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC)?
A. Your members may seek services from one of these clinics when the clinic is part of your provider panel.
Q. Are these clinics required to charge our members a copayment? A. These clinics are required to charge your members a copayment. See OAR 410 Division 147 for useful information on this topic. Back to top Q. What happens when our member seeks services from a provider that has not been authorized by us to render care to that member? A. You approve services for your members. You are not obligated to pay a provider for care you have not approved (unless it is an emergency). This is true even if the provider collected a copayment from your member. The provider should check the Medicaid Identification of your member before serving the patient. This includes confirming the patient’s benefit package and managed care plan. Back to top Q. What advantage does managed care offer me as a Medicaid provider? A. There are benefits to being on the provider panel of one of our contracted managed care plans: Your reimbursement is higher. Managed care plans usually pay more for services rendered to Medicaid patients than we pay on a fee-for-service basis. We use fee-for-service for patients who are not enrolled in a managed care plan. You have access to highly developed systems. Our contracted managed care plans have continuous quality improvement practices. Access to those resources can help you address issues facing your patients. You may not have that expertise within your own practice. If not, you may find it more difficult to carry out quality improvement activities. Back to top This page updated Sept. 2006. |
|
