Provider information and benefit tracker

Online information about medical eligibility, benefits, claims and referral information.

Information and resources

Medical

• OHSU Health Services referral and authorizations
• OHSU Health Injectable Medication Prior Authorization list
• OHSU Health Services Medical Prior Authorization List
• OHSU Health Services Injectable Medications Post Services Claim Edits Program
• OHSU Health Services Injectable Drug Program FAQ's 
• EviCore advanced imaging procedures and services requiring prior authorization
• EviCore cardiology procedures and services requiring prior authorization

Provider resources

• Provider/ office manager training materials | presentation
• Provider Network Meetings
  • 6/11/20 presentation
  • 9/23/20 presentation
• Provider manual
• Telemedicine guidelines
• Health related services request form
• OHSU Health Services Recuperative Care Program Request Form
• NEMT: Ride to Care
  • Appointment verification form
  • NEMT provider letter
  • For general questions, please contact medicaltransportation@careoregon.org.
• Contact my provider representative. Email our office or call 503-418-7750 with any questions.

• OHSU Health Services seeks to provide a diverse network of providers for our members.  Providers interested in joining the network may complete either the provider information form for individual providers or the group form to be considered for contracting and credentialing. Form must be completed in its entirety. Submission of the provider information form does not guarantee network participation. Fax the completed form to 503-346-8041 Attn: Provider Relations or email to OHSUHealthPrvRelations@ohsu.edu . Questions?  Call 503-418-7750.

Pharmacy

• Formulary
• Formulary updates for October and November
• Medication authorization request
• Prior authorization guidelines
• Step therapy guidelines
• Machine readable formulary

OHP and OHSU Health forms

Below are forms and links you may need.

Advanced directives

Oregon Health Decisions provides information and tools for Health Care Providers on their website. Learn more.

Oregon State Agency Requested Medical Records – Anytime an Oregon state agency is requesting medical records, they will provide one of two forms to providers. If the patient is an Oregon Health Plan member on the date of service, the agency will provide Form 729 which allows the provider to bill the Division of Medical Assistance Programs for the cost of medical record copying charges (and mailing if applicable). In order to be paid by DMAP, the provider must complete an HCFCS 1500 and attach the Form 729 for the claim to be processed by DMAP. While the form offers a physical mailing address as a means to submit these forms, it is more efficient (and trackable) to submit using the EDI portal (the same portal used to process Open Card submissions). Questions about the portal should be directed to DMAP Provider Relations at 800-336-6016. If the patient is not an Oregon Health Plan eligible member on the date of service, the agency will provide Form 501A which allows the cost of the medical record copying charges (and mailing if applicable) to the Oregon General Fund (through the agency requesting the records).

• Resources Book 2019

Physical Health Clinical Guidelines

• Abdominoplasty/Panniculectomy
• Push Rim-Activated Power-Assist Device for a Manual Wheelchair
• Intravitreal Avastin 
• Air Ambulance
• Urinary Incontinence Treatment 
• Anesthesia for Endoscopic Procedures 
• Allergy Testing – Blood
• Hydrogen Breath Testing
• Iron Therapy
• Serum Antibodies for Diagnosis of Inflammatory Bowel Disease
• Surgical Treatment for Achalasia
• Therapeutic Drug Monitoring
• Vagus Nerve Stimulation (VNS)