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Medical Management Policies and Forms This page has updates to CareOregon medical policies, forms and Medical Management guidelines. Criteria for Utilization Management Decisions Please click the link below to review the criteria used for utilization management decisions for CareOregon Advantage (COA) and CareOregon OHP. Click here to view the criteria in a PDF format. Authorization Guidelines Injectables billed under the medical benefit require prior authorization. Go to the Pharmacy page to find the CareOregon Formulary, updates and forms. Authorization Overview The Authorization Overview has information on verifying a member’s eligibility with CareOregon and using the Prioritized List. Changes are posted to this page on the 15th day of the calendar month or the next business day. Authorization Guidelines by Plan 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
Frequently Asked Questions (FAQ's) Authorization Request Forms
OHMS providers Only:
Miscellaneous Policies and Forms
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