OAR 410-121-0200: Billing Forms

Guidelines for using the Prescription Drug Invoice 1.2 Universal Claim Form. (1) When a paper claim form is needed, this form is used to bill for all pharmacy services, home blood glucose monitors, and related diabetic supplies. These services must be billed with a National Drug Code (NDC). (2) The provider may bill on the form when a valid Medical Care Identification has been presented (Refer to OAR 410-120-1140 Verification of Eligibility). (3) All completed 1.2 Universal Claim Forms must be mailed to the Health Systems Division (Division). (4) All other durable medical equipment and certain Enteral/Parenteral Nutrition and IV Services must be billed on the CMS-1500, using the billing instructions found in the Division’s Durable Medical Equipment and Medical Supplies administrative rules (division 122) and Supplemental Information, and the Division’s Home Enteral/Parenteral Nutrition and IV Services Administrative rules (division 148) and Supplemental Information. These services are billed with HCPCS procedure codes. NOTE: Publications referenced are available from the agency.