Provider updates

Considering the uncertainty within the Medicaid landscape, as well as variability in provider billing systems, CareOregon has made the decision to adjust our approach to changes in psychotherapy billing.

Previously we planned to deny claims retroactively to January 1, 2024, for psychotherapy services exceeding eight (8) hours in a single calendar day. We recognize that this could place an undue burden on providers during an already challenging period.

As a result, CareOregon will no longer implement retroactive denials or recoupments for these claims.

Aligning with standard billing expectations for psychotherapy services supports high-quality, medically necessary care while allowing us to uphold the highest standards of accuracy, integrity, and regulatory compliance. We remain committed to working with providers to navigate the ever-changing healthcare landscape so we can continue supporting Oregonians.

We will also be contacting providers who were previously informed about potential retroactive denials to clarify this change, and coordinate with those providers to ensure that claims are appropriately paid for services rendered.

If you have questions, please contact Payment Integrity at paymentintegrity@careoregon.org