Why a claim may be denied for enrollment or screening, and how to get enrolled for the plan you bill.
Ayin is proud to serve, and partner with, community-based health plans whose goal is to achieve a better state of health for those most underserved. Healthcare providers are an important part of this mission. We aim to make submitting claims efficient for providers and billing agents, without unnecessary processing barriers. Some restrictions are set by the federal government to ensure payment integrity and patient safety. Below are the outcomes for claims we can’t process because of enrollment and screening requirements.
Why was my claim denied?
Select the reason shown on your remittance advice.
CARC 185 · RARC N767
Medicaid enrollment
Federal law (CFR 455.410) requires all providers and billing agents receiving federal payments to be enrolled with the state Medicaid agency, the Oregon Health Authority (OHA).
To be eligible to enroll, practitioners in Oregon must have an NPI (National Provider Identifier), be licensed, and be currently registered by the appropriate state agency. Out-of-state practitioners must have an NPI, be licensed, and be currently registered by the appropriate agency in their state. Other providers must be approved, have an NPI, be licensed or issued a permit, and be certified by the appropriate state agency (or, if applicable, certified under Medicare).
We want to help you enroll. Complete the enrollment application for your health plan below and supply any required supporting documentation. All providers, even those who don’t bill OHP Medicaid but provide services to beneficiaries, are required to enroll. Applications are screened against federal and state guidelines before an enrollment decision (CFR 455.450). Keep copies of your application materials for your records. You’ll receive a response when your enrollment with OHP Medicaid is approved or denied.
Don’t see the plan you’re billing? Call (503) 315-4130, Monday through Friday, 8am to 5pm.
Capital Dental Care
If you’re submitting a billing or ownership enrollment request, fill out the Provider Disclosure Statement of Ownership (OHA 3974) and date and sign it by hand. See OHA provider enrollment for the current form and guidance.
Submit your enrollment request through the Ayin help desk, attaching the OHA 3974 if it applies.
Note: If your claim was denied with CARC 185 for non-enrollment, please don’t rebill the same claim. All affected claims on file will be reprocessed automatically.
Questions about enrollment? Call (503) 315-4130, Monday through Friday, 8am to 5pm.
After you’ve returned the form, resubmit your claim so it can be processed correctly.
Health Share of Oregon CCO, Behavioral Health
If you’re submitting a billing or ownership enrollment request, fill out the Provider Disclosure Statement of Ownership (OHA 3974) and date and sign it by hand. See OHA provider enrollment for the current form and guidance.
Submit your enrollment request through the Ayin help desk, attaching the OHA 3974 if it applies.
Note: If your claim was denied with CARC 185 for non-enrollment, please don’t rebill the same claim. All affected claims on file will be reprocessed automatically.
Questions about enrollment? Call (503) 315-4130, Monday through Friday, 8am to 5pm.
Managed Dental Care DCO
If you’re submitting a billing or ownership enrollment request, fill out the Provider Disclosure Statement of Ownership (OHA 3974) and date and sign it by hand. See OHA provider enrollment for the current form and guidance.
Submit your enrollment request through the Ayin help desk, attaching the OHA 3974 if it applies.
Note: If your claim was denied with CARC 185 for non-enrollment, please don’t rebill the same claim. All affected claims on file will be reprocessed automatically.
Questions about enrollment? Call (503) 315-4130, Monday through Friday, 8am to 5pm.
Primary Health of Josephine County & Umpqua Health Alliance
After you’ve returned the form, resubmit your claim so it can be processed correctly.
Willamette Valley Community Health CCO
If you’re submitting a billing or ownership enrollment request, fill out the Provider Disclosure Statement of Ownership (OHA 3974) and date and sign it by hand. See OHA provider enrollment for the current form and guidance.
Submit your enrollment request through the Ayin help desk, attaching the OHA 3974 if it applies.
Note: If your claim was denied with CARC 185 for non-enrollment, please don’t rebill the same claim. All affected claims on file will be reprocessed automatically.
Questions about enrollment? Call (503) 315-4130, Monday through Friday, 8am to 5pm.
Yamhill CCO
If you’re submitting a billing or ownership enrollment request, fill out the Provider Disclosure Statement of Ownership (OHA 3974) and date and sign it by hand. See OHA provider enrollment for the current form and guidance.
Submit your enrollment request through the Ayin help desk, attaching the OHA 3974 if it applies.
Note: If your claim was denied with CARC 185 for non-enrollment, please don’t rebill the same claim. All affected claims on file will be reprocessed automatically.
Questions about enrollment? Call (503) 315-4130, Monday through Friday, 8am to 5pm.
CARC B7
Exclusion list
Federal law (CFR 455.450) requires all providers and billing agents to be screened before enrolling, and monthly after that, with any health plan funded directly or indirectly by the U.S. government. This includes programs that provide health benefits, such as Medicaid and Medicare. Screening includes federal database checks and license verification.
If a provider or billing agent submits a claim to Ayin and is found to be excluded from participation, and therefore ineligible for reimbursement, the provider or billing agent will receive a remittance advice with the following for the submitted claim(s):
CARC B7
This provider was not certified/eligible to be paid for this procedure/service on this date of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
CARC B7 · RARC M143
License expiration
Federal law (CFR 455.450) requires all providers and billing agents to be screened before enrolling, and monthly after that, with any health plan funded directly or indirectly by the U.S. government. This includes programs that provide health benefits, such as Medicaid and Medicare. Screening includes federal database checks and license verification.
If a provider or billing agent submits a claim to Ayin and the rendering, ordering, or referring provider’s license or certification has expired, the provider or billing agent will receive a remittance advice with the following for the submitted claim(s):
CARC B7
This provider was not certified/eligible to be paid for this procedure/service on this date of service. Usage: Refer to the 835 Healthcare Policy Identification Segment (loop 2110 Service Payment Information REF), if present.
RARC M143
The provider must update license information with the payer.
