Medical Billing Services in Oregon
Billing, coding, credentialing and denial management for Oregon practices, with Medicare claims through Noridian Healthcare Solutions (Jurisdiction JF) and Oregon Medicaid handled by people who know the rules.
Medical billing for Oregon practices
Oregon runs Medicaid through coordinated care organizations, so most Oregon Health Plan members belong to a regional CCO such as Health Share of Oregon, PacificSource Community Solutions or Trillium. Commercial volume is spread among Regence, Providence Health Plan, Kaiser Permanente, Moda and PacificSource, and Medicare Advantage enrollment is high. Practices in Portland, Salem and Eugene work alongside rural clinics in central and eastern Oregon that depend on OHP.
Medicare Part B claims go to Noridian Healthcare Solutions in Jurisdiction F. Oregon has a uniform practitioner credentialing application, and each CCO keeps its own rules. SFA Solutions works with practices across Oregon remotely from Austin, inside your existing EHR, submitting most clean claims within 24 hours and working denials toward payment.
Oregon at a glance
| Medicare contractor | Noridian Healthcare Solutions, Jurisdiction JF |
|---|---|
| Medicaid timely filing | 12 months from the date of service for OHP fee-for-service claims (OAR 410-120-1300); claims denied within that window can be resubmitted up to 18 months from the date of service. CCOs set their own limits by contract |
| NP practice authority | Full |
| Cities we serve | Portland, Salem, Eugene, Gresham, Hillsboro, Beaverton, Bend, Medford, Springfield, Corvallis |
What Oregon billing involves
These are the programs and rules our team works with for Oregon claims.
Medicare
Noridian Healthcare Solutions · JFOregon Part B claims are processed by Noridian Healthcare Solutions in Jurisdiction JF. Medicare's filing limit is 12 months from the date of service, and appeals start with a redetermination within 120 days of the initial decision.
Oregon Medicaid
Oregon Health Plan (OHP), Oregon's Medicaid program, administered by the Oregon Health Authority (OHA)
Portal: OHA MMIS Provider Web Portal for enrollment, eligibility and fee-for-service (open card) claims, processed by OHA
Medicaid managed care
Most members are enrolled in a coordinated care organization. CCOs include Advanced Health, AllCare CCO, Cascade Health Alliance, Columbia Pacific CCO, Eastern Oregon CCO, Health Share of Oregon, InterCommunity Health Network, Jackson Care Connect, PacificSource Community Solutions (Central Oregon, Columbia Gorge and Marion/Polk), Trillium Community Health Plan (Southwest and Tri-County), Umpqua Health Alliance and Yamhill Community Care.
Timely filing
12 months from the date of service for OHP fee-for-service claims (OAR 410-120-1300); claims denied within that window can be resubmitted up to 18 months from the date of service. CCOs set their own limits by contract.
Commercial and Medicare Advantage
Regence BlueCross BlueShield of Oregon, Providence Health Plan, Kaiser Permanente, Moda Health and PacificSource are the main commercial carriers. These carriers, along with UnitedHealthcare and Humana, also offer Medicare Advantage plans in the state.
Prompt pay law
Oregon law (ORS 743B.450) requires insurers to pay or deny a clean claim within 30 days of receipt, with another 30 days after receiving any additional information they request.
Nurse practitioners
Full practiceOregon NPs are independently responsible for managing patient care and can prescribe, including controlled substances, within their specialty and scope under Board of Nursing rules. They enroll with Medicare, OHP and commercial carriers under their own NPI.
Credentialing
Oregon sets a uniform Oregon Practitioner Credentialing Application under ORS 441.223, and many plans also pull data from CAQH ProView. Enroll with OHA as an OHP provider first, then contract with each CCO separately. Medicaid enrollment must be revalidated at least every five years.
Billing challenges Oregon practices face
Regional CCO rules
Each CCO sets its own authorization lists, behavioral health arrangements and provider manuals. Practices near CCO boundaries, such as the Portland suburbs, may need contracts with several CCOs.
Open card versus CCO enrollment
Some OHP members are fee-for-service (open card), while most are assigned to a CCO. A claim sent to OHA for a CCO member, or the reverse, will deny, so eligibility must be checked on the date of service.
Washington patients in the Portland metro
Practices in the Portland area treat many Washington residents with Washington Apple Health or Washington commercial plans. Those claims follow Washington payer rules and often require separate enrollment.
Our services in Oregon
Medical Billing
Learn moreCredentialing & Payer Enrollment
Learn moreMedical Coding
Learn moreDenial Management
Learn moreA/R Recovery
Learn moreEligibility Verification & Prior Authorization
Learn moreMedical Billing Audit
Learn moreRevenue Cycle Management
Learn moreSpecialties we bill in Oregon
Oregon medical billing questions
What is the timely filing limit for Oregon Health Plan claims?
OHP fee-for-service claims must be filed within 12 months of the date of service under OAR 410-120-1300. CCOs set their own filing limits in provider contracts. Check each CCO's current provider manual.
How quickly must Oregon insurers pay clean claims?
ORS 743B.450 requires insurers to pay or deny a clean claim within 30 days of receipt. If the insurer requests more information, it has 30 days after receiving it to decide.
Who is the Medicare contractor for Oregon?
Noridian Healthcare Solutions processes Medicare Part A and Part B claims for Oregon under Jurisdiction F.
Can nurse practitioners in Oregon bill independently?
Yes. Oregon grants NPs full practice authority. NPs enroll and bill under their own NPI with Medicare, OHP and commercial carriers.
Get a free billing audit for your Oregon practice
We will review your recent claims and denials against Oregon payer rules and show you what can be recovered.
Nearby states
Primary sources
- CMS: Who are the MACs, A/B MAC Jurisdiction F (JF)
- OHA coordinated care organizations
- OHA: How to Resolve Fee-for-Service Claims
- ORS Chapter 743B (see 743B.450)
- OAR 851-055: Scope and Standards of Practice for the APRN
- OHA: Advisory Committee on Physician Credentialing Information FAQ
Payer rules change. Last reviewed against the primary sources above on . Confirm current rules with the payer before relying on them.
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