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Providers that are currently set up to send electronic claims to Oregon Medicaid, CPIDs 1481 and 5517 must submit the updated Exhibit C portion of the agreement by January 1, 2012 in order to prevent claim disruption. New providers enrolling after December 5, 2011 only need to complete the Trading Partner Agreement, and the Exhibit A and B forms. These forms are currently available on Collaboration Compass in the Payer Agreement Library.

Please note that the authorized signer that signed the original trading partner agreement must also sign the new Exhibit C form in order to prevent denial. If you require assistance determining who signed the original form, please contact the payer at 1-888-690-9888. If the individual that signed the original form is not able to sign the new Exhibit C form, the original trading partner packet must be completed with a new authorized signer.

Action Required: Existing providers must complete the Exhibit C form prior to January 1, 2012 to avoid an interruption in claims processing. New providers continue to complete the new agreement. The forms are currently available on Collaboration Compass in the Payer Agreement Library.

If you have any questions, please contact Client Services at 1-888-348-8457, Option 2.

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