Effective immediately, for dates of service of January 1st, 2021 and on, ambulance services need to be billed on a professional (CMS-1500) claim form in order to be in compliant with the Oregon Administrative Rules. EOCCO systems have been configured to deny these services on a hospital (UB) claim form. We will request that you rebill on a CMS-1500 claim form in order for the claim to be paid and properly encountered with the State.
Additional resources from the Oregon Administrative Rules that support this change:
410-125-0220–Services Billed on the Electronic 837I or on the Paper UB-04 and Other Claim Forms
(11) Hospital operated air and ground ambulance services. A hospital which operates an air or ground ambulance service may apply to the Division for a provider number as an air or ground ambulance provider. If costs for staff and equipment are reported on the Medicare Cost Report, these costs must be identifiable. The Division will remove these costs from the Medicare Cost Report in calculating the hospital's cost-to-charge ratio for outpatient services. These services are billed on the electronic 837P (837 Professional) claim form or the paper CMS-1500 in accordance with the rules and restrictions contained in the Medical Transportation Program rules (chapter 410, division 136).
This is also confirmed under the Medical Transportation Services Provider Guide that does also confirm when billing Medicare as primary to bill on a professional claim format. Medicare will process your claim for ambulance services and automatically forward it to OHA or EOCCO depending on the plan the member is enrolled in.
If you have questions, please contact eoccoproviderinquiry@modahealth.com
