Provider support

Please call Provider Customer Service at 503-416-4100 or 800-224-4840. Press option 3 for provider.

 

Care Management Department

Fax: 503-416-3676 or 800-862-4831

 

Verifying clinics’ email addresses

CareOregon is confirming clinics’ email addresses to ensure we can contact you with system alerts and other critical information. Please send the email address(es) that you want CareOregon to use when contacting your clinic to careoregonalerts@careoregon.org. Be sure to identify each email with a name and job title.

 

Need to change your clinic info?

Send changes or updates to providerupdates@careoregon.org.

Provider relations specialists
View our team assignments list to find your specialist. Fax us at 503-416-1478 or 800-874-3916.

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.

CareOregon provides plan services to three Coordinated Care Organizations (CCO) and offers a Medicare Advantage plan supporting and enhancing sensible, localized, coordinated care.

If you are interested in becoming a contracted provider, please review our credentialing requirements (outlined in our CareOregon Provider Manual).

If you have additional questions, or would like to learn more about requesting consideration for a contract, please contact Customer Service at 800-224-4840 or 503-416-4100. You may also complete the New Contract Requests form here. Please be certain to include all applicable fields for consideration.

Thank you for your interest in joining CareOregon’s provider panel!

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

Electronic HIPAA Transactions

The AMA recognizes electronic health care transactions as a cost saving, efficient way to do business and allows physicians to refocus resources on patient care. The links below provide information regarding various electronic transactions such as submitting claims, receiving payments and remittance advices.

To access your remittance advice electronically:

• Remittance advice FAQ

To receive payments via Electronic Funds Transfer (EFT):

CareOregon provides a couple of options for electronic payment.

1. 1. Enroll with CareOregon ePayment Center, administered by Zelis for ACH direct deposit payment, at no cost. Please contact Zelis at 855-774-4392 or help@epayment.center for instructions on how to register and enroll. Please note, TIN verification is required for registration and enrollment.
   • Zelis EFT Online FAQs
2. 2. Enroll with Zelis Payment Network for ACH direct deposit payment or virtual credit card for a small fee (this is separate from CareOregon’s free ePayment ACH option noted above). To enroll with the Zelis Payment Network, go to their website at https://www.zelis.com/provider-enrollment/, or you can call them at 855-496-1571.
   • Please note: CareOregon is not involved in any relationship with providers and Zelis Payments. It is strictly between Zelis and you, the provider.

To receive electronic remittance advice:

• 835 form: Please complete and fax back to the number listed on the bottom of the form
• 835 information guide
  • Important: 835 enrollment is available through CareOregon ePayment Center, administered by Zelis. If enrolling with the ePayment center, please do not submit this form. Instead, select the option for 835 enrollment upon registration through the ePayment center.

To submit claims electronically:

• To submit claims electronically, use the same EDI Payer ID #93975 for all CareOregon entities (CareOregon Dental, CareOregon Advantage and CareOregon Medicaid claims). Do not bill separately for each plan.
• For EDI claims for which additional paperwork or documentation will be submitted, complete this form and indicate submission in the PWK segment (Loop 2300). 
• Contact your practice management system vendor or clearinghouse to initiate electronic claim submission. CareOregon accepts HIPAA-compliant 837 electronic claims through our clearinghouse, Change Healthcare. Change Healthcare will validate the claims for HIPAA compliance and send them directly to CareOregon. Change Healthcare offers several solutions for providers without a practice management system or clearinghouse. Contact them at 866-369-8805 for medical claims and 888-255-7293 for dental claims.

Columbia Pacific CCO wants to help you and your patients have the best experience, which is why we help you coordinate live interpreters for patients who speak a language other than English. Please click here for resources like interpreter request forms, a language ID tool for your office, OHP “I speak” cards and more.

Training documents  can be found here.

CareOregon takes fraud, waste and abuse very seriously. If you suspect that benefits aren't being used correctly or want to report a case of waste, abuse or fraud, please contact Ethics Point at 888-331-6524. You also can file a report online at  www.ethicspoint.com.

Model of Care Training presentation for providers

Training documents can be found here.

If you have questions please contact Melodie Farmer Quality Assurance Program Manager, Medicare Population Health Partnerships at farmerm@careoregon.org or 503-416-4631.

Quality Metrics Toolkit

2022 CareOregon Quality Metrics Toolkit - all measures (Updated June 2022)

Model of care training: Presentation (PPTX) | Attestation 

• MMIS (OHP provider web portal)
• OHP web portal training
• Sign up for OHP updates