Resources Available for CareOregon Advantage Providers
By Patrick Curran, Medicare director

Last CareNews, we gave you information about our new Medicare plan, CareOregon Advantage. Our plan is now up and running, with approximately 6,000 members.

First, we want to thank all providers within the CareOregon Advantage service area - Clackamas, Clatsop, Columbia, Marion, Multnomah, Polk, and Washington counties - for your participation.

We also want to highlight several items to help you and your CareOregon Advantage patients:

• Web site – Visit the main Provider page of the CareOregon web site. It has a benefits summary, sample ID card, link to the Provider Manual chapter on Medicare, and other items.

• Referrals and authorizations – Click to view CareOregon Advantage's list of services and procedures that require prior authorization.

• Claims – Submit claims to the same mailbox or payer identification number (electronic claims) as our OHP plan.

• Part D formulary – Search our formulary for coverage of specific drugs on our web site for CareOregon Advantage.

• Part B drugs – Remember to bill us for Part B drugs supplied (through injection) in an office setting. Go to our medical policy page to read and download our policy for authorizing these drugs.

• Payment – If you provide services to a CareOregon Advantage member and the member also has our OHP plan, you only need to bill us once! We will send you an explanation of benefits (EOB) for CareOregon Advantage and, if the member has CareOregon for OHP, we will pay the remaining amounts automatically and send you a CareOregon EOB.

• PCP assignment – We have assigned all CareOregon Advantage members to the PCP they have for our OHP plan. If you are a primary care clinic within the CareOregon Advantage service area, you will be listed as accepting new Medicare Advantage members. We do not expect significant numbers of new patients, and you can close your clinic to new patients by contacting your Provider Relations representative.

• Nurse advice line – We are happy to offer CareOregon Advantage members a 24-hour nurse advice line. We sent a letter to members reminding them of this number, which is 503-574-9666 or toll-free 888-227-3401. (TTY/TDD users should call 711 and ask for one of these numbers.) PCPs will receive a summary of the calls for their patients.