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Duties and responsibilities
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Do’s
1. Provide Oregon Health Plan (OHP) application packets and enrollment assistance for all clients potentially eligible for OHP benefits.
2. Encourage OHP applicants to provide accurate and complete information on their applications.
3. Establish a date of request for all OHP applicants by date stamping the application with the date the client requested the application.
4. Provide information to potential OHP applicants covering the following information:
a. Basic OHP/Medicaid eligibility criteria
b. Managed health care requirements
c. Criteria for choosing a health care, mental health or dental plan
d. How to enroll in a managed care plan or with a Primary Care Manager (PCM)
e. Potential services that may be covered under OHP and those that are not covered
5. Provide unbiased managed care choice counseling.
6. Make copies of required eligibility verification information and submit copies along with the application to the OHP Central Processing branch.
7. If a correction is made to an application, the error must be crossed out, corrected and initialed.
8. Provide quarterly reports to DHS on the number of applications distributed each month of the quarter.
9. Send two or more employees to DHS outreach training session when first contracted, keeping a minimum of two employees trained at any one time.
Don’ts
1. Don’t attempt to pre-determine OHP eligibility or make assurances regarding an applicant’s eligibility.
2. Don’t alter date stamps or back-date applications.
3. Don’t white-out information on an application.
4. Don’t fill in missing information for the client.
5. Don’t choose health plans for the client.
6. Don’t guarantee or imply eligibility determination.
7. Don’t advocate with DHS for a client’s eligibility status.
8. Don’t deny or discourage anyone from applying for OHP.
9. Don’t use unpaid volunteers or non-facility employees to perform outreach responsibilities.
10. Don’t remove the OHP date stamp from the facility named in your contract.
11. Don’t order application forms for any site other than your own.
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