Member Resources

Click a topic to learn more about these member resources

• Member Handbook

  The Columbia Pacific CCO Member Handbook is available in the following languages:

  • English
  • Español

  If you would prefer a printed copy of the handbook, call Customer Service at 855-722-8206 (TTY 711). There’s no charge, and you’ll receive a copy within five business days. You may also receive a copy in large print or in languages other than English.

• Oregon Health Plan Handbook

  The OHP Handbook is available in the following languages.

  • English
  • Español

  You may also receive a copy in large print or in languages other than English. Call the Oregon Health Authority (OHA) at 800-699-9075 to have a copy of the OHP Handbook mailed to you.

• Language interpreter services

  If you need an interpreter for visits or phone calls to your (or your child’s) provider’s office, you are legally entitled to this service free of charge. When you join Columbia Pacific, you may receive a Preferred Language card. This card helps you tell your provider’s office about your spoken language. The card shows the preferred language you chose on your insurance application. Show this to your provider to receive interpretation.

  For phone interpretation, call our Customer Service when you’re at the doctor, dentist or pharmacist or making an appointment.

  Call Customer Service if you ask for an interpreter but don’t get one. It’s important for us to know so we can follow up and improve the process.

• Member forms

  Below is a list of some of the most frequently used forms. Click on a link to open the form in PDF format.

  • Direct Member Reimbursement form (prescription drugs)
  • Authorization to Release Personal Health Information (PHI) form
  • Member Request to Review Claims Records form

• Your Member ID card

  When you become a Columbia Pacific member, we’ll mail you a Member ID card within 30 days. Your Member ID card lists your primary care provider (PCP). It also lists important contact information. The card looks like this:

  

  Take your Member ID card and your Oregon Health ID card to all health care and dental appointments and to the pharmacy when you fill a prescription.

  Reasons to take your card with you:

  • It’s easier to check in for appointments.
  • It’s easier to get medicine at a pharmacy.
  • Your provider will know who to bill.
  • Providers use information on Member ID cards to make sure you have benefits with us.

  If you or a family member switch to a different PCP, we’ll send you a new Member ID card. If you lose your ID card, call Customer Service and we’ll send you a new one.

• Are my prescriptions covered? View the drug list

  Columbia Pacific pays for many prescription drugs. The ones we cover are on a drug list called a “formulary.” When your provider prescribes a medicine, ask if it’s on the covered drug list. The list is a directory of medications approved for Columbia Pacific CCO members. It explains if there are special rules about the drug. The list is updated often, so if we remove or change a medication that you take, you’ll be notified in advance. To download and view the drug list, click the link below.

    
     2020 Columbia Pacific CCO OHP Drug List (Formulary)

  
  

   

  Search for a drug in one of the following ways:

  1. Find the drug listed in the formulary/PDF index.
  2. In the PDF file, enter the drug name into the search box located in the menu.
  3. Call Customer Service for assistance in finding a drug.

  If you want us to send you a printed copy of this formulary, please contact Customer Service. There is no charge, and you’ll receive it within five business days.

  If you urgently need a drug that’s not on our formulary, call Customer Service. You, your provider or your pharmacist can ask for an emergency supply. The maximum emergency supply is 72 hours’ worth.

  To fill a prescription, go to any pharmacy in our network. You’ll have lots of choices. Our network includes most large pharmacy chains and many smaller drug stores.

• Other prescription drug resources

  OptumRx is your one-stop pharmacy benefits resource:

  • Search for network pharmacies.
  • View your prescription history.
  • Look up a prior authorization status.
  • And more!

  Create an account and get the information you need to manage your health.

  Go to OptumRx

  
  
  

• Transportation assistance

  Do you need help with transportation to your health care appointments?

  Non-emergency medical transportation (NEMT) services are a covered Medicaid benefit for Columbia Pacific members. If you have no way to get to a covered health appointment, a rideshare program called NW Rides can get you there. Depending on your needs, you may be provided rides, get passes to ride the bus or get help paying for gas. Contact NW Rides toll-free at 888-793-0439 to talk about your transportation options.

  Call center hours

  Monday-Friday
  8 a.m. to 5 p.m.
  503-861-0657
  Toll-free: 888-793-0439
  TTY: 711
  
  The call center is closed on New Year’s Day, Memorial Day, Fourth of July, Labor Day, Thanksgiving Day and Christmas Day. NW Rides’ services are provided 24 hours a day, 365 days a year. To arrange after-hours or weekend transportation, call as far ahead as possible to schedule your rides.

  Frequently asked questions about transportation

  Q: When can I schedule a ride?
  A. If you need help getting to your appointments, call NW Rides up to 30 days and at least two days before the appointment. The NW Rides staff will ask you some questions about your health history. They’re happy to explain which services will fit your needs.

  Q: Am I eligible?
  A: NW Rides will confirm your eligibility before providing services. NEMT services are provided to any eligible Columbia Pacific CCO member. NW Rides will ask you what resources you have and guide you on how to use them. This includes, but doesn’t guarantee, options to access public transit passes, mileage, lodging and meal reimbursement, shared rides, volunteers and mobility vehicles.

  If you are enrolled in open card/fee-for-service Oregon Health Plan, please contact Oregon Health Authority to find out whom to call for NEMT services.

  Q: Can my children or family ride with me?
  A: No. Transportation services are covered only for the Columbia Pacific member who has the appointment. There is one exception: If you need assistance during your ride, a personal care attendant, such as a nurse or aide, can ride with you at no charge.

  Q: Where can I go?
  A: You may schedule transportation to and from any covered health service, including:

  • Primary care visits
  • Specialist office visits
  • Physical therapy
  • Dental care visits
  • Mental health services
  • Dialysis
  • Substance use treatment services
  • Other health services covered by Columbia Pacific CCO

  Q: What kind of transportation am I eligible for?
  A: We’ll arrange the lowest cost option that meets your needs. Available services may include:

  • Bus fare
  • Pre-approved mileage reimbursement
  • Wheelchair lift/ramp van
  • Sedan/taxi
  • Stretcher van (for those who need to be transported lying down)
  • Secured transport (professional transport for those in a mental health crisis)

  Q: What information do I need to have ready when I call?
  A: Please have this information ready:

  • Your Columbia Pacific CCO Member ID number
  • Your home address and phone number
  • Your mailing address
  • Your complete pickup address and phone number
  • Your complete appointment address, including building name and suite number
  • Appointment date and time
  • Name and telephone number of your medical provider
  • Reason for appointment
  • If you need a wheelchair or other assistance

  Q: What if my plans change or I need to cancel my ride?
  A: If you need to cancel a ride or change your appointment time, call NW Rides at least two hours before your ride is scheduled to pick you up (or as soon as possible).

  You can call to cancel rides Monday through Friday, 8 a.m. to 5 p.m. NW Rides has 24-hour voicemail, so you can leave your cancellation and they will get to it first thing in the morning.

  Q: Is there a number to call after business hours?
  A: If you need to reach NW Rides after hours, please call the call center at 888-793-0439 (TTY 711). You can leave a voice message stating your need for a ride and someone will call you back.

  Q: What happens if I don't show up for my ride?
  A: If you’re not ready at your pickup time and have not canceled the ride at least two hours before the scheduled time, the ride is called a no-show. Continued no-shows may result in a transportation provider refusing to continue providing service. Transportation providers do not get paid for no-show rides. There are limited number of transportation providers under contract with NW Rides. Therefore, you must make every reasonable effort to avoid no-shows and cancel unnecessary rides on time. Failure to cancel in a timely manner may limit available transportation resources. This places undue burdens on NW Rides and makes transportation more difficult for all our members.

  Q: What else do I need to know?
  A: Please keep these things in mind:

  • You should be ready 15 minutes before your scheduled pickup time. Transportation providers should arrive within 15 minutes before or after the scheduled pickup time. If the driver is late, call 503-861-0657 or toll-free 888-793-0439.
  • Bus passes should be requested at least one week before your appointment. This allows time for mailing.
  • For urgent needs after hours, you can still contact Customer Service.
  • The Tillamook County Transportation District website has more information if you need it. This includes bus routes.
  • Click here to download the NW Rides Reimbursement Guide to understand your options if you or someone you know provides transportation to your medical appointments.

• Member rights and responsibilities

  As an OHP member, you will be:

  • Treated with dignity, respect and privacy.
  • Free to choose your primary care provider (PCP).
  • Urged to tell your PCP about all your health concerns.
  • Able to have a friend or helper come to your appointments. You can also have an interpreter if you want one.
  • Told about all your OHP-covered and non-covered treatment options.
  • Allowed to help make decisions about your health care, without being kept away from other people or forced to do something you don’t want to do. This includes refusing treatment.
  • Given a referral or second opinion, if you need it.
  • Given care when you need it, 24 hours a day and seven days a week.
  • Free to get mental health and family planning services without a referral.
  • Free to get help with addiction to tobacco products, alcohol and drugs without a referral.
  • Given handbooks and letters that you can understand.
  • Able to see and get a copy of your health records.
  • Able to limit who can see your health records.
  • Sent a Notice of Action letter if you are denied a service or there is a change in service level.
  • Given information and help to appeal denials and ask for a hearing.
  • Free from any form of restraint or seclusion (isolation) that is not medically necessary or is used by staff to bully or punish you. Staff may not restrain or isolate you for their convenience or retaliation against you. You have the right to report violations to Columbia Pacific CCO and/or the Oregon Health Plan.
  • Allowed to make complaints and get a response without a bad reaction from your plan or provider.
  • Free to ask the Oregon Health Authority Ombudsperson for help with problems. They can be reached at 503-947-2346 or toll-free 877-642-0450 (TTY 711).

   

  As an OHP member, you agree to:

  • Find a doctor or other provider you can work with and tell them about your health.
  • Treat providers and their staff with the same respect you want.
  • Bring your Member ID card to appointments, tell the receptionist you have OHP and any other health insurance, and tell them if you were hurt in an accident.
  • Be on time for appointments.
  • Call your provider as soon as possible if you can’t make it to an appointment.
  • Have yearly check-ups, wellness visits and other services to prevent illness and keep you healthy.
  • Follow your providers’ and pharmacists’ directions or ask for another choice.
  • Be honest with your providers to get the best service possible.
  • Call OHP Customer Service when you move, are pregnant or no longer pregnant.

• Renewing and applying for Oregon Health Plan coverage

  The Oregon Health Authority (OHA) sends you a coverage letter that has your:

  • Benefit package
  • Coordinated care plan name

  This letter shows information for everyone in your household who has an Oregon Health Plan (OHP) ID card. You do not need to take this letter to your health care appointments or to pharmacies. OHA will send you a new coverage letter if you ask for one or if your coverage changes.

  OHA sends you one OHP ID card that has your name, Member ID number and the date the card was issued. All eligible members in your household receive their own OHP ID cards.

  Keep your OHP ID card in a safe place. OHA only sends a new card if you change your name or ask for a new card. If your OHP ID card is not correct, or you get a new card with your name but a different Member ID, call OHP Customer Service right away at 800-699-9075 (TTY 711).

  To keep your Oregon Health Plan coverage, you must re-apply every 12 months. OHP will send you a letter about how to keep your coverage.

  There are three ways to contact OHP for questions or to make updates to your current information:

  1. By telephone (toll-free): 800-699-9075

  Members can call OHP to do any of the following:

  • Change your address, phone number, family status, CCO or other information
  • Replace a lost OHP Card
  • Check the status of your application
  • See if you or your children are still covered by OHP
  • Change plans
  • Solve a problem or make a complaint
  • Get an OHP Handbook

  2. By email: oregonhealthplan.changes@state.or.us When you write to this address, you must include your full name, date of birth, Member ID number and phone number.

  Existing members can email OHP to change your address, phone number, family status, CCO or other information. PLEASE NOTE: the email address is for changes only.  

  3. Online: Most OHP members can report changes online at ONE.Oregon.gov. The online site supports the following browsers. (If you don't know your browser version, click your browser's Help menu, then click About.)

  • Windows (PC): Internet Explorer 11, Internet Explorer 10, Internet Explorer 9, Internet Explorer 8, Firefox 39.0 and 43.0 and Chrome 43.0 and 44.0.
  • Macintosh: Firefox 39.0 and 43.0 and Chrome 43.0 and 44.0. Safari is not supported.
  • Smartphone browsers are not supported.

  Need help?

  • Learn how to set up your online account. English | Español
  • Learn to use your online account dashboard. English | Español
  • Watch a five-minute overview of the Applicant Portal.

   

  OHP information for currently enrolled members:

  • About your benefits
  • Announcements
  • When you need help

  OHP information for potential members:

  • Are you eligible?
  • How to apply
  • For more information