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 firstname.lastname@example.org 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
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
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:
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:
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.