GOBHI Billing and Claims

Companion Guides

Claims Submission Guide

GOBHI 837 File Testing Guidelines

GOBHI 837 Production File Guidelines

Check Eligibility

While you can access our Provider Portal to check eligibility of members, we always recommend accessing the State of Oregon Medicaid Management Information System (MMIS) for the most current eligibility information.

Timely Filing

GOBHI requires that all eligible claims for covered services be received within 120 days of the date of service. If a claim meets one of the following criteria, GOBHI may waive the 120-day timely filing rule:

  • Billing is delayed due to eligibility issues;
  • Pregnancy of the Member;
  • Medicare is the primary payer;
  • Cases involving Third-Party Resources;
  • Other reasonable circumstances for delay

Failure to furnish a claim within 120 days shall not invalidate or reduce any claims if it was not reasonably possible to submit the claim within the required period, provided it is submitted as soon as reasonably possible. Claims received later than 12 months after the date of service are invalid and not payable. Providers may not balance bill the member for services that were denied for not meeting the timely filling requirements.

Appeal Process

Providers have the opportunity to request that the Plan reconsider a claim decision. Providers have 60 calendar days from the date of the Explanation of Benefit (EOB) to submit a Claims Appeal Form for reconsideration. The Claims Appeal Form can be found under the forms section of our website. If the claim appeal results in an adjusted claim, the provider will receive a revised EOB.

Submitting a Corrected Claim

Oregon Health Plan

What is the Oregon Health Plan?

The Oregon Health Plan (OHP) provides health care coverage for low-income Oregonians from all walks of life. This includes working families, children, pregnant women, single adults, seniors and more.
Visit the Oregon Health Authority’s Oregon Health Plan page to learn more.

What is a coordinated care organization?

A coordinated care organization is a network of all types of health care providers (physical health care, addictions and mental health care and dental care providers) who work together in their local communities to serve people who receive health care coverage under the Oregon Health Plan (Medicaid). CCOs focus on prevention and helping people manage chronic conditions, like diabetes. This helps reduce unnecessary emergency room visits and gives people support to be healthy.

Learn more at oregonhealthstories.com 

How do coordinated care organizations work?

CCOs are local. They will have one budget that grows at a fixed rate for mental, physical, and ultimately, dental care. Initially the state needs to reduce the Medicaid cost trend by two percent from the current funding levels. CCOs will be accountable for health outcomes of the population they serve. They are governed by a partnership among healthcare providers, community members, and stakeholders in the health systems that have financial responsibility and risk.

GOBHI

Who is GOBHI?

Greater Oregon Behavioral Health, Inc. (GOBHI) is a nonprofit, National Committee for Quality Assurance (NCQA) accredited Managed Behavioral Health Organization. GOBHI is an Oregon Health Plan administrator engaging in a variety of innovative services and initiatives to improve health and wellness across Oregon’s rural and frontier communities.

Our work in the Eastern Oregon Coordinated Care Organization improves the system of care, promotes better health outcomes, and lowers costs through effective integration with physical, behavioral, and oral health.
GOBHI continues to raise the bar by investing in prevention and social determinants of health. We advocate at local, state, and national levels for what works along the full continuum of healthcare services.

Because we recognize that no singular healthcare entity can improve the system of care in isolation, we forge dynamic partnerships with our friends and neighbors across the healthcare universe. GOBHI works closely with local planning groups, schools, child welfare, senior services, mental health, addictions, corrections, and other key groups. We believe in prevention, recovery, and positive outcomes.

We have a contract with the State of Oregon to manage mental health services under the Oregon Health Plan, and to help members access services that we do not manage.

What counties does GOBHI serve?

We provide services through the community mental health programs in the following counties: Baker, Gilliam, Grant, Harney, Hood River, Lake, Malheur, Morrow, Sherman, Umatilla, Union, Wallowa, Wasco and Wheeler.

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Contact Us:

Email
claims@gobhi.org

Mail
GOBHI
Attn: Claims Department
401 E. 3rd St, Suite 101
The Dalles, OR 97058

Phone
541-705-4994

Fax
541-298-7996