DMAP administrative rules and other information for:
Federally Qualified Health Centers & Rural Health Clinics program
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Rulebook
October 1 , 2011 (pdf) (current administrative rules; see below for archived rules) 10/3: corrected OAR # from 410-147-0320 to 410-147-0362 on Update Information page.
Attention: Rules filed after October 1, 2011 have not been included in the Rulebook. Rules filed after October 1, 2011 are listed below:
- March 22, 2012 – 410-147-0362 Change in Scope of Services
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Supplemental information
Federally Qualified Health Centers and Rural Health Clinics Supplemental Information (pdf) - Updated 9/27/11 - Includes billing and prior authorization information, instructions, and forms.
National Drug Code (NDC) Billing Tips (pdf) This document explains how to enter NDC information on medical and institutional outpatient claims for codes that require NDC reporting (e.g., physician-administered drugs). Also see DMAP's frequently asked questions about NDC requirements (link).
Forms
EDMS Coversheet (pdf) - Use this form whenever you fax documentation for prior authorization requests, provider enrollment requests, or claims to DMAP.
DHS Prior Authorization Request Form - Use this form to submit faxed PA requests to DMAP. Click here for instructions. You can also submit the same information using the Provider Web Portal. Read the handbook or view the tutorial for more information about submitting PA requests on the Web.
Who to call for help
Provider Services 800-336-6016 or e-mail us
Address
and telephone contacts
Other information
See also: FQHC-RHC rulebook history
See also: Ancillary Services Criteria
See also: Pharmaceutical Services clinical information
See also: Tools for providers