Providers - What's New for Providers

What's New for Providers

QNXT enhancements coming soon!

ALERT: We expect to post PCP assignment information in QNXT View on August 18. You’ll notice more information on your CareOregon patients:

The most current “real time” list of OHP members currently assigned to your clinic. NOTE: You will continue to receive a paper roster by mail once each month.
Expanded information on claim denials

When assignment data is available in QNXT, do not use MCNet. We will confirm the MCNet deactivation date on this web page.

Please register and use QNXT View as soon as possible. If you have questions, please contact your Network Relations Associate.

2008 CareOregon OHP Prior Authorization
Use Criteria for Selected Drugs

This document contains use criteria for the most commonly requested drugs that require prior authorization or step therapy or are not on the CareOregon/Oregon Health Plan (OHP) formulary. Click here to view the criteria in a PDF format.

The CareSupport Program

The CareSupport Program provides multidisciplinary, person-centered case management services to CareOregon members who: (1) are at risk for or experiencing a functional health decline because of lack of appropriate supports or self management, (2) are using the health care system ineffectively or inappropriately, or (3) are experiencing a significant health-related transition in their life, such as hospital discharge to home with advanced disease. CareSupport staff work to optimize the productive interaction between the patient and provider, working closely with both the patient in becoming informed and activated and the medical team in being prepared and proactive in the medical home.

Please review additional information about the CareSupport Program and how we can work with you to improve the health of your patients.

CareOregon wants to hear from you: Provider satisfaction improvement project

Physicians, facilities and other providers are vital partners in achieving CareOregon’s mission to ensure access to high-quality health care for Oregon’s vulnerable populations.

To make sure that providers’ experience with CareOregon is the best it can be, we’ve launched a process improvement team, the Barrier Breakers.

The Barrier Breakers will address several areas to increase provider satisfaction, said Rebecca Fortuine, the team’s co-leader.

Full story >>

Meet your Network Relations Associates

You know us as Provider Relations Representatives. We’ve been pondering a name change that would encompass all the groups we work with – hospitals, vendors, physicians, nurse practitioners, office staff and more. The “relations” piece is the core of our work, so that stays. All of us are partners working on common goals, so “associates” came to mind. Voila! Our new title: Network Relations Associates. Our updated territory assignment list has our phone numbers and e-mail addresses.

Measles alert

If you see a patient with an illness compatible with measles, immediately contact your county health department or call DHS Oregon Health Services, 971-673-0300, for help with investigation and preventive therapy.

Oregon physician alert: measles

Tamper-resistant Prescriptions

The Federal tamper-resistant prescription pad requirement that began on April 1, 2008, DOES NOT apply to CareOregon members.

Changes regarding diabetic supplies

Effective January 1, 2008, CareOregon members may not receive their diabetic supplies from retail pharmacies. Please click here for information sent to PCP, OB and Endocrinology clinics.

Care Support and System Innovation Program

The CareOregon Care Support and System Innovation (CSSI) Program responds to the Institute of Medicine’s (IOM) “call to action to improve the American health care delivery system” (Crossing the Quality Chasm: A New Health System for the 21st Century). This transformation of health care will include a balance or optimization of performance on the three dimensions of care that the Institute for Healthcare Improvement (IHI) calls the “Triple Aim:” 1) the health of a defined population; 2) the experience of care by the people in this population; and 3) the cost per capita of providing care for this population.

The goal of the CSSI Program is to foster a culture of evidence-based practice and continuous improvement in CareOregon provider organizations, helping to empower providers over time with the skills, knowledge and resources to create the substantial change necessary to meet IOM’s quality and IHI Triple Aim transformational goals.

Downloadable materials:

Please contact Diana Wolford, CSSI program coordinator at wolfordd@careoregon.org or (503) 416-1725 for further information.

CareNews

CareNews delivers relevant, thought-provoking, engaging and entertaining information about new provider programs and initiatives. Celebrate the accomplishments of health professionals who are making a difference, every single day. Learn about how clinic and hospital staff are implementing innovative ways of delivering care. View the latest edition of CareNews.

Medicare Advantage

CareOregon Advantage provides Medicare and Part D prescription drug benefits to qualified members. You can enroll in CareOregon Advantage if you are eligible for both Medicare and Medicaid coverage and live within a nine-county service area: Clackamas, Clatsop, Columbia, Jackson, Josephine, Marion, Multnomah, Polk and Washington.

Completed surveys from recently enrolled CareOregon Advantage Members were recently mailed to Providers. Based on these surveys, if you wish to refer a CareOregon member to the CareSupport Team assigned to your practice, please complete this referral form and fax it back to us at the number indicated on the bottom of the form. It is extremely helpful if you indicate the type of support that you feel would most benefit your patient as indicated on the referral form.
Primary care providers who participate in our Medicare Advantage plan are responsible for obtaining a signed advance directive from each Medicare member and placing it in the member's chart, or have documentation showing that the member refused to sign an advance directive. Click here to view and print a copy of the advance directive form. To learn more about advance directives, click here.

Visit our Medicare web site: www.careoregonadvantage.org for more information about this plan.

Note: To view .pdf documents, you must have Adobe Reader installed. Click here to download the free Adobe Reader program.