Updates from Provider Relations
By Karry Donnelly, CareOregon Provider Relations Manager and Kim Thomas, Provider Services Coordinator
Pharmacy Benefit Manager Change
On January 1, 2007 we changed our pharmacy benefit manager from MedImpact to RxAmerica for both our Medicare and Medicaid lines of business. For additional information please visit http://www.careoregon.org/provider/documents/PBMchanges.pdf to review the notice mailed out to providers at the end of November.
Network Additions in Southern Oregon
CareOregon is very excited to announce a new PCP contract, effective December 1, 2006, with the seven primary care clinics at Providence Medford known as Providence Medical Group South. These PCP clinics were previously only available to CareOregon members for specialty consults. After a health plan orientation and system training provided by Sharon Madara, the rural Provider Relations representative and her co-worker, Gloria Hughes, the Providence System representative, these clinics are ready to provide care to CareOregon members in a PCP capacity. We look forward to a long and mutually supported relationship with the PMG South clinics.
HPV vaccine covered under VFC program
As of December 1, the new human papilloma virus (HPV) vaccine will be added to the list of immunizations covered in Oregon under the federal Vaccines for Children program. This vaccine will be covered for females ages 9-18. Please refer to section H of the online provider manual for instructions on billing guidelines to receive accurate reimbursement. For additional information on HPV please refer to the VFC program information available on the DMAP web site.
Phasing out McNet
CareOregon’s online resource, McNet, which currently displays member PCP assignment information for both Medicare and Medicaid members, will soon be phased out. Our new online claims payment system QNXT, will soon be able to support this function. Please stay tuned to the “What’s New” section of the provider page on our website for posted updates on when this will occur. If you have not registered for a QNXT user ID, we would like to take this opportunity to encourage you to do so. You will find comprehensive instructions on how to register under the Mcnet/QNXT provider page of our web site. If you have further questions about this transition, please contact your Provider Relations Representative by calling our main line 503-416-4100 or you may verify PR territory assignments from our resource page on our web site to contact your PR directly.
Provider Satisfaction Survey
It’s that time of year again! The Provider Satisfaction Survey should be hitting your mailbox in the next couple of weeks. Your feedback truly does make a difference. CareOregon has increased training for its online systems and changed our referral and authorization process as a result of past responses. We really appreciate your time and effort when filling out the survey, and this year we want to reward you! All who participate will have a chance to win one of several gift cards.
