Provider Resources

Click on a topic to learn more about these provider resources

• Provider Manual

  Columbia Pacific CCO providers are contracted with CareOregon, the health insurance provider that works with Columbia Pacific. Below you will find the CareOregon Provider Manual, which also applies to CareOregon Advantage/Medicare contracted providers.

  CareOregon Provider Manual

  This 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 record
  • Quality improvement
  • Credentialing
  • Medicare Advantage
  • Clinical practice guidelines

  If you have questions, please contact your provider relations specialist.

• Policies and forms

  This section includes medical policies, forms and medical management guidelines for physical and behavioral health. Some documents are provided by CareOregon, the health insurance provider that works with Columbia Pacific. For dental health information, visit the provider page of the appropriate plan:

  • Advantage Dental
  • CareOregon Dental
  • ODS
  • Willamette Dental Group

   

  Behavioral health guidelines and forms

  • Mental Health Levels of Care
  • Treatment Authorization form (applied behavioral analysis services)
  • Behavioral Health Outpatient Provider requirements 

   

  Opioid prescribing guidelines

  • Persistent Pain and Opioid Prescribing guidelines (PDF)

   

  Policies: General

  • Criteria used for utilization management decisions

   

  Policies: Pharmacy

  • OHP Prior Authorization Use criteria

   

  Forms: Pharmacy

  • Home Infusion Prior Authorization form
  • Prior Authorization and Formulary Exception Request form
  • Injectable Authorization form
  • Hospice Prior Authorization form
  • Chemotherapy Prior Authorization and Formulary Exception Request form 
  • Hepatitis C Therapy form (OHP only)
  • Nutritional Supplement Medication Request form
  • Synagis Medication Request form
  • Opioid Prior Authorization form Dynamic PA (OHP only)
  • Pharmacy Provider Reconsideration Request form

   

  Policy updates and other forms: Pharmacy

  • Authorization policy: Injectables/Medications Administered Under the Medical Benefit (August 1, 2019)
  • Authorization policy: Injectable Drugs for Bleeding and Clotting Disorders (July 1, 2019)

   

  Authorization guidelines and forms

  Eligibility

  Use the Provider Portal to verify a member’s eligibility with Columbia Pacific CCO.

   

  Authorization guidelines 

  Changes are posted on the 15th day of the calendar month (or the next business day).

  • Medicaid and Medicare Authorization guidelines

   

  Diagnostic and treatment procedures: CPT code grid

  • Authorization guidelines by CPT code

   

  DME: Authorization and code lists

  • DME No Auth Required list
  • DME Change of Vendor Request form 

   

  Authorization request forms

  • Enteral/Parenteral Prior Authorization form
  • DME Prior Authorization form
  • HOME INFUSION prior authorization 
  • 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)
  • Limb Prosthetic Prior Authorization form 
  • SNF-IPR-LTAC Authorization Request form (OHP and Medicare)
  • RCP Authorization Request form (OHP)

   

  Frequently asked questions (FAQs)

  • Comorbid conditions FAQs
  • Dental transition FAQs
  • DME and supplies FAQs
  • National Drug Code (NDC) requirements FAQs

  Miscellaneous policies and forms

  • Oregon Medicaid ID Application form
  • Referral form: CareOregon Dental
  • Referral form: Early Intervention/Early Childhood Special Education (EI/ECSE)* birth to age five
  • Complex Care Case Management Referral
  • Interpreter Request form
  • Provider Claim Appeal form
  • Client Agreement to Pay for Health Services form: Medicaid (OHP)
  • Oregon Health Authority Primary Care Provider Attestation
  • PCP Re-Assignment Request form (OHP and Medicare)
  • Health-Related (Flex) Services Policy and Request form
  • Hospital-based Credentialing Notification form
  • Member Incentive form

• Where to send claims

  To submit claims electronically, use EDI Payer ID #93975. Paper claims can be mailed to:

  Columbia Pacific CCO
  C/O CareOregon Claims
  PO Box 40328
  Portland, OR 97240

• Drug list (formulary)

  The drug list (or formulary) is a directory of all preferred medications approved for Columbia Pacific members. This list is administered and provided by CareOregon. To download and view the drug list, click on the link or thumbnail below.

  [PDF image] 2019 Columbia Pacific CCO OHP drug list (formulary)
  
  You can 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.

   

  Formulary updates

  Columbia Pacific makes regular formulary updates when necessary. These usually occur monthly.

  • Formulary Update (PDF, updated 6/1/2019)
  • Formulary Update for Opiates (PDF, Effective 1/1/2017)
  • Formulary Updates - New Generics (PDF, Effective 5/1/2019)