Medical Management Policies and Forms

This page lists updates to CareOregon medical policies, forms and Medical Management guidelines.

Authorization Guidelines

Authorization Overview

The Authorization Overview provides information to determine a member’s eligibility with CareOregon benefit plans and instructions on how to use the Prioritized List.

Authorization Guidelines by Plan

• Oregon Health Plan (OHP) Plus
• Oregon Health Plan (OHP) Standard
• CareOregon Advantage Plus and Star

Diagnostic and Treatment Procedures - CPT Code Grid

Revised to include, for all the CareOregon Health Plans, Plus, Standard and Advantage Plus and Star, the authorization guidelines by CPT code.

DME - Auth & Code lists

• DME Code/Modifier resource (OHP and Medicare)
• DME No Auth Required List (OHP and Medicare)

Frequently Asked Questions (FAQ's)

• DME and Supplies FAQ's
• Prior Authorization Requirements FAQ's

Authorization Request Forms

• Authorization Form for DME, Home Health and Home Infusion (OHP and Medicare)
• Facility Authorization Form (OHP and Medicare)
• Office/Clinic Authorization Form (OHP and Medicare)

Miscellaneous Forms

• Complex Care Case Management Referral (Medicare and OHP)
• Appointment of Representative Form (Medicare)
• DME Change Of Vendor Request Form (Medicare and OHP)
• Interpreter Request Form (OHP and Medicare)
• Patient Responsibility for Uncovered Services Form (OHP)
• Provider Claim Appeal Form (OHP and Medicare)

Medicare and OHP Policies

• DME Immediate Need Policy
• Therapies (Occupation, Physical and Speech) - OHP Plus

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