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Guidelines for THW Doulas Serving OHP Members

Once you are a state-registered THW Doula, being able to serve clients who are Oregon Health Plan (OHP) members requires additional steps to be able to submit claim forms for payment. First, your certification letter should be kept handy, as it has your effective date, certification ID# and date of expiration. You will need to submit copies for certain entities. If you have not already applied for an individual NPI#, you should do that next.

On the application, put: Entity Type 1 Individual with SSN Provider type #13

Once you have your NPI#, you have two choices on how you will be able to bill for your services. As of July 1, 2018, new rules went into effect for doulas to be able to bill directly for services. In most areas, THW Doula “Hubs” have been, or are being, established so THW Doulas can bill as groups, rather than individuals. The health care system prefers this as it is cumbersome to deal with a lot of individuals submitting claim forms, and frankly, the billing process requires exactness and follow-up in order for claims to be paid in a timely manner. However, an individual option is now available if needed and information on this option follows below. Both Doula Hubs and individual billers may contact me via email (debcatlin@aol.com) for an instructional document on how to complete claim forms.

Doula Hub Billing Providers

THW Doula Hubs may be a business, agency, or community organization that has applied and been approved by the state of Oregon as a TYPE 09 or TYPE 09-059(Doula Specific only) Billing Provider. They may also be enrolled with one or more Coordinated Care Organizations (CCOs) that serve the OHP members in your area or are seeking to do that. They will have established a client referral system with area care providers and ongoing networking meetings with THW Doulas who work with them. Please contact me, Debra Catlin, at debcatlin@aol.com for current list of Doula Hubs around the state.

The THW Doula Hub will have you establish a contract with them and also enroll you as a Non-payable provider with DMAP on Form 3113 to receive a Provider ID number. They will need the information below and fax it in for you:

Your Name, Individual NPI#, Social Security #
A physical service location address such as your home, business address, agency address, or a non-profit community organization address, plus a mailing address if different.
Oregon Medicaid Provider type: 13
Taxonomy code: 374J00000X Specialty code: 600
Licensing Board: OEI

Also give them a copy of your THW Doula Certification Letter that shows your effective date, expiration date, and Certification number.

You will then receive a welcome letter from the state’s Medical Assistance Program (MAP) with a Provider ID # and be entered into the MMIS (Medicaid Management Information System). You will receive a PIN# from MAP which can be used to check client eligibility on all clients and follow-up on any Fee for Service claims. If a group is billing for you, they will do that on your behalf but you would if you are billing individually, as described below. Once you receive it, you have 30 days to log in to activate yourself in the system and create your own login.

You must keep your state provider file updated with any change of address by going to Form 3035 Download Form
Fax it to (503) 947-1177.

Before your THW Doula Certification expiration date passes, send in a copy of the new OEI letter with the new expiration date. Write your Provider ID# on it and fax it to (503) 947-1177.
If mail is returned to the state or you do not update your THW Certification, you will be termed.
If you update your information before six months, you will be activated again. After six months, you will have to be re-enrolled.

Individual Billing Provider

If there are no THW Doula Hubs established in your area, you might work with any doula businesses or community-based organizations in establishing one. If this is not possible, you may apply to be approved as an Individual Billing Provider. You will need to enroll through Provider Enrollment Enroll Now

Under the Provider Description table, find Doula (not the organization type) and click on the forms you will need. Do not forget the cover sheet when you fax it in. You will then receive a welcome letter from Medical Assistance Program (MAP) with a Provider ID # and be entered into the MMIS (Medicaid Management Information System). You will receive a PIN# from MAP and you would use this to check all client eligibility and when you bill MAP for Fee for Service clients. You will need to approach the care CCOs in your area to set up claims processes.

Establishing THW Doula Services

There are two categories of OHP members. The majority (92%) of them are served under CCO management and the rest are Fee For Service members. Once you have your billing service arrangements made, if you are working with a Doula Hub, they may refer clients to you. Otherwise, you will need to contact the CCO(s) that serve OHP members in the area you wish to provide services. They will now enroll you into their claims system and discuss how referrals are handled. Contact their Credentialing Department to do this. The maternity care providers who work with the CCOs will also need to be educated on the program, the role of the doula, and how to make referrals. Potential clients also need to know more about having a doula.  You may use this brochure template with the appropriate information found on this Google Docs link: View Doc

The document is editable, so copy it and download it into your own document before making changes to it. It contains a place for information to be put on it about how to contact local THW Doulas.

In some areas, CCOs are contracting with THW Doulas for services, and this means you would become one of their preferred providers and be paid at a higher rate of reimbursement. They will require you to complete an Oregon Practitioner Credentialing form: Download Form

Their credentialing department will assist you in completing the form. Once this is done, they will enroll you as one of their paneled providers on Form 3108.

As you contact provider clinics in your area, you should give the business office a copy of your Welcome letter, and your Certification letter. If any contract agreements have been negotiated with a CCO for doula services your ID#’s should be added onto your contract as well.

Working With OHP Clients

As a THW Doula, it is important to determine how many and how often you provide doula services to OHP members.  Ideally, you are available to be the Primary Doula for the client. Being available to provide all of the prenatal visits, birth care and postpartum follow-up visits allows for the continuity of care that is crucial for creating the rapport and trust that will carry through the whole relationship between you. This element is the hallmark of doula care, especially when serving prioritized populations. While back-up will also need to be arranged, it should be reserved for those situations where illness or emergency occurs, or you are attending another birth.

Most referrals for THW Doula services will come through care providers to your THW Doula network, business, or organization. THW Doula services must be requested through the member’s care provider so it can be noted in the patient’s chart. Once an OHP member has selected you as their primary doula, you or your client need to give your name and contact information to the care provider so that this may be done. If an OHP member contacts you first, and was not referred by the care provider, make sure that person asks for doula services through them before any commitment is made to the client.
Though no money will be exchanged between you and the client, a contract between you should be signed. In addition to the provisions and expectations you normally have in your contract with clients, here are some additional things to add or emphasize:

1) The understanding that you are booking time in your schedule to serve the client and that you will only be paid upon completion of the services (unlike private pay clients);
2) An agreement to keep contact information current to respond by phone, text, or email in a timely manner;
3) That no additional monies can be paid to you by the client (Medicaid rules) for any reason;
4) A clause that states that the client is agreeing to accept these services and their signature is considered to be “on file” for billing purposes;
5) That you have discussed your role and scope of practice, and what your care package includes in terms of # of prenatal visits, birth care, and postpartum visits;
6) Your policies on your availability by phone or in person, and what the focus will be during your prenatal and postnatal visits;
7) That your care does not include any medical advice or clinical care and that you will refer them back to their care providers for that information;
8) That they contact you when they go into established labor, as you mutually define it during the prenatal visits;

When you arrive at your client’s birth place, have the nurse or midwife document your name and the time you arrived in the chart. Afterwards, have the nurse, doctor, or midwife update the chart with the time that you left.

About billing for your THW Doula Services

After you have signed a contract with your billing provider, you should submit the information they need from you to them right after the birth so that they can send in a claim form for you. Though you have not completed the postnatal visits yet, it is customary for the services to be billed at this time. Do make sure to document your postnatal visits and keep records of them, should you be audited.

Also, you need to submit an OHP Client Doula Services Record to the care provider to be added to the client’s medical chart. An editable template can be found on this Google Docs link: View Doc

The document is editable, so copy it and download it into your own document before making changes to it. The process for doing this would be a part of your contract with the doula business or organization you are working with.

Have a Question or Comment?  Contact Me Now.

541-912-1864

debcatlin@aol.com

1047 Colony Pond Drive

Eugene, OR  97405

I am so fulfilled with the Birth Doula training. I feel it has been one of the most rewarding educational experiences of my life. Deb is a great teacher, detail oriented, stays on topic, fills up the whole time, and is a great compassionate speaker. She was able to answer all questions in great detail. I feel confident that I will be able to go out and put this training to use and serve mommas of the world. Thanks for all the tools for success.

Betsy Goodman
Rating: 5
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