Medical Management Policies and Forms

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

Authorization Request Forms

• Authorization Form for DME, Home Health and Home Infusion (OHP and Medicare)
• Authorization Form for non-hospital services (OHP and Medicare)
• Authorization Form: Referral to Bariatric Surgeon (OHP)
• Hospital Authorization form (OHP and Medicare)
• Injectables Billed to the Medical Benefit Form (OHP)
• Injectables Billed to the Medical Benefit Form (Medicare)

Chemical Dependency Forms

• Chemical Dependency Program Monthly Roster (OHP)
• Drug Free Clinical Justification for Extended Treatment (JET) Form (OHP)
• Methadone Treatment Services Treatment Authorization Request (TAR) Form (OHP)

Miscellaneous Forms

• 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)

Pharmacy Forms

Pharmacy Forms have been moved to the Pharmacy page.

Medicare and OHP Guidelines

• DME Future Dates of Service Billing (Medicare and OHP)
• DME No Auth List (Medicare and OHP Plus)
• Prior Authorization Guidelines and Code List (Medicare)
• Prior Authorization Guidelines and Code List (OHP Plus)
• Prior Authorization Guidelines (OHP Standard)

Medicare and OHP Policies

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

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