Guidelines for serving members
Best practice guidelines are intended to ensure appropriate and consistent utilization of mental health and SUD services and to provide a frame of reference for providing service to CareOregon/Health Share members. You can view these standards and guidelines by referencing the resources below.
- Behavioral Health Non COA Providers Documentation Standards (PDF)
- Behavioral Health COA Providers Document Standards Checklist (PDF)
- SUD Providers Documentation Standards Checklist (PDF)
- Outpatient Behavioral Health Provider Requirements (PDF)
- Provider Guide to Billing Out-of-Network
- Find this guide below in Claims & Billing Resources for either pre or post 10/1 dates. - Neurofeedback Frequently Asked Questions (PDF)
- CareOregon Best Practice Guidelines page
Provider portal
To access CareOregon’s secure provider portal, including logins, signups and portal tutorials, visit our Provider Portal webpage by clicking the button below.
Payments
To ensure access for our members, CareOregon pays both qualified in network and out-of-network providers for authorized behavioral health services provided to CareOregon/Health Share members. To learn more, visit our BH Qualified Directed Payments (BH QDP) web page.
CareOregon Behavioral Health System Integration (BHSI)
In 2023, CareOregon will transition Metro behavioral health claims and authorization administration from CIM/PH TECH to CareOregon’s internal operating systems. Read the full announcement in the CareOregon system integration update.
We will be providing the latest news and information on the transition at the BH Billing and Admin Meetings.
- CareOregon Billing and Admin meeting presentation - October 31, 2024
- CareOregon Billing and Admin meeting recording - October 31, 2024
- BHSI FAQs
- BHSI Acute/Inpatient Provider Guide
We want to hear from you! Submit your questions through the provider question form.
Training for the CareOregon Connect Portal
In preparation for the October 1st, 2023 Connect system go-live, CareOregon’s Provider Relations (PRS) team hosted several educational training sessions on how to navigate the Connect Portal for Behavioral Health. Check out the resources below!
More behavioral health resources
Please carefully review all procedures before rendering any services to members. CareOregon’s policies, procedures and authorization requirements are described above in “Guidelines for serving members.” You also may find additional resources for doing business with CareOregon in the tabs located below.
Click here to download the Behavioral Health Utilization Management Procedure Handbook.
Utilization management forms and resources:
ACT/ICM
- Adult Level D/ICM Referral Form
- Level D Child Referral Form
- ACT Referral Face Sheet
- OHA ACT Universal Referral Form
- ACT criteria
- ICM criteria
Substance Use Forms
For information on where to send claims, how to sign-up for EFT or electronic remittance, and other claim inquiries, please refer to the "Submitting claims and receiving payment" section of our Provider Support page.
- Post-Service Behavioral Health Claims Reconsideration/Appeal Form (PDF)
- Provider Guide to Billing out of Network for Post-10/1/2023 Dates of Service (PDF)
- Noncontracted MH & SUD Fee Schedule for Post 10-1-23 claims
- CIM / OneHealthPort / Connect MMIS Guide
- BHSI Online Resource Diagram
-
BHSI Who To Contact For Help? Quick guide
- Metro Area Behavioral Health Credentialing Resources
- Metro Area Behavioral Health Non CoA Credentialing
- CareOregon Credentialing Checklist
- EDI Training Opportunity Handout
- HSO Provider peer FAQ
- HSO Narrative Access Report
- Care Coordination for Certified Community Behavioral Health Clinics FAQ
- Medicare Demystified training
For more detailed information on claims, authorizations, data reporting and other topics, please see the Metro Area Behavioral Health Provider Manual
Click here to download the Behavioral Health Utilization Management Procedure Handbook.
Utilization management forms:
- Contracted providers may register as a new provider and gain CIM access by visiting the PH TECH Help Center at help.phtech.com and submit a request. (Learn more here.)
- Contracted providers may visit theCIM Provider Portal to log in to your CIM account and access additional CIM provider tools, like the CIM Provider Manual.
- For additional support, please contact PH TECH Provider Customer Service at 503-584-2151
Please ensure you request and activate your EFT registration codes with Payspan
Contact us
BHSI Transition
See details for who to contact regarding services provided before and after 10/01 in our BHSI Who to contact for help? quick guide (pdf)
Provider Portal
For most needs, we recommend using CareOregon Connect, our online provider portal. This includes topics such as, but not limited to, submitting authorization requests, reviewing authorization and claim status, viewing/retrieving remittance advice, requesting PCP changes, viewing member rosters and member eligibility.
Provider Customer Service
Reach out to our Provider Customer Service Team at 800-224-4840 (option 3) for questions regarding the online provider portal, billing and authorization inquiries, claim and authorization appeals, general CareOregon guidelines and questions that the portal cannot answer.
Provider Relations Specialist
If you have further questions, you can contact the provider relations specialist assigned to you.
