Provider Manual
The CareOregon Provider Manual can be used by CareOregon/Oregon Health Plan and CareOregon Advantage/Medicare contracted providers. The manual has information on the following topics:
- Membership
- Benefits
- Referrals and authorizations
- Billing and payment
- Interpretation
- Transportation for OHP members
- Provider Relations Specialists
- Primary care
- Medical records
- Quality improvement
- Credentialing
- Medicare Advantage
- Clinical practice guidelines
Provider Portal
To access CareOregon Connect, visit our Provider Portal webpage.
More resources
For information on other resources, select a topic below.
Policies and forms
This section includes CareOregon’s medical policies, forms and medical management guidelines.
Forms change and are updated here on a regular basis, so please be sure to return to this page for the most up-to-date forms and policies.
Eligibility
Use the provider portal to verify a member’s eligibility with CareOregon.
Authorization guidelines
Changes are posted on the 15th day of the calendar month (or the next business day).
CPT code grid: Diagnostic and treatment procedures
DME: Authorization and code lists
- DME No Auth Required List (OHP and Medicare)
- DME of Immediate Need (OHP and Medicare)
- DME Change of Vendor Request form (OHP and Medicare)
- ARCHIVES: CPT and DME No Auth Lists and Guidelines
Frequently asked questions (FAQs)
Authorization request forms
- Enteral/Parenteral Prior Authorization form
- Dental Hospitalization Authorization form (OHP and Medicare)
- Inpatient Authorization form (OHP and Medicare)
- Retro Facility Authorization form (OHP and Medicare)
- Retro Office Clinic Authorization form (OHP and Medicare)
- SNF-IPR-LTAC Authorization Request form (OHP and Medicare)
- RCP Authorization Request form (OHP)
- Behavioral Health Treatment Auth Request Forms available here
Medicare behavioral health policy and form
- Admission Through Discharge Checklist
Miscellaneous policies and forms
- Oregon Medicaid Practitioner Application form
- Oregon Medicaid Organization Application form
- Outpatient Palliative/Advanced Illness Care Referral form
- Referral Form: Early Intervention/Early Childhood Special Education (EIECSE) Birth to Age 5
- Care Coordination Referral Form (OHP and Medicare)
- Appointment of Representative form (Medicare)
- Linguava Interpreter Request form (OHP and Medicare)
- Provider Post-Service Claim Reconsideration/Appeal form (OHP and Medicare)
- Client Agreement to Pay for Health Services form: Medicaid (OHP)
- Waiver of Liability form (Medicare)
- Oregon Health Authority Primary Care Provider Attestation
- PCP Re-Assignment Request form (OHP and Medicare)
- Provider Information form
- Traditional Health Worker Provider Enrollment form
- Doula Enrollment form
- Member Request to Review Claim Records form
- Direct Member Reimbursement form (prescription drugs)
- Member COVID-19 At Home Test Reimbursement form
- Health-Related (Flex) Services Policy
- Health-Related (Flex) Services request form
- Health-Related Services: K Plan Letter request
- Health-Related Services: Hotel flex request
- Health-Related Services: Hotel Liability form
- Health-Related Services: Hotel request checklist
- Health-Related Services: Bulk request form instructions
- Health-Related Services: Bulk request form
- Health-Related Services: Budget worksheet
- Health-Related Services: States of Emergency Request form instructions
- Health-Related Services: States of Emergency Request form
- Hospital-based Credentialing Notification form
- Member Incentive form: English | Spanish | Arabic | Traditional Chinese | Simplified Chinese | Russian | Somali | Vietnamese
- Member incentives frequently asked questions
- Housecall Providers referral form
- Housecall Providers patient handout
- Housecall Providers FAQ and primary care referral instructions
- Relinquishment form
- COA Notice of Medicare Non-Coverage template - English
- COA Notice of Medicare Non-Coverage template - Spanish
- CareOregon Diabetes Resource Guide
- Appointment of representative form
Contact us
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.
