Search
Menu
Am I Eligible?
Members
Benefits overview
Physical health
Find a Provider or Pharmacist
Pregnancy and family support
Dental health
Mental health and substance use treatment
OHP information
OHP covers undocumented children and teens
Find us in your community
Medications
More CareOregon services
Help getting the care you need - Coordinated care
Health-related services
Traditional health workers
Transportation
Language services: Interpretation and translation
Tribal Care Coordination
Getting and staying healthy
Nutrition and activity
Vaccines
Health screenings
Flu
Stop smoking
Living Well with Chronic Conditions
Pregnancy
Child and teen health
Women's health
Men's health
Developmental screening
Dental sealants
Diabetes
Pneumonia
Asthma
Alcohol / Drugs
Improving Heart Health
Winter Weather Resources
Get involved with CareOregon
Community Advisory Board (COCAB)
News and stories
Member Portal
Extreme heat resources
Coronavirus (COVID-19) member information
Telehealth
Oregon Wildfire Recovery Resources for Clackamas, Washington and Multnomah County
Privacy and Third Party Apps
Providers
Provider support
Provider Manual
Policies and Forms
Quality Metrics Toolkit
Electronic HIPAA Transactions
MMIS / DHS
2020 important updates about OHP and metro-area CCOs
Provider updates
Language services
Physical health providers
Provider Portal
Provider Portal Tutorials
Administrator - How to Add, Modify and Remove User
Metro area behavioral health providers
Pharmacy resources
MEDS Ed
Formulary List and Updates
Prior Authorization Criteria
Best practice guidelines
Tobacco Cessation
Immunizations
Diabetes
Oral Health
ADHD
Asthma
Preventive Services
Substance Use Disorders
Depression
Living Well Workshops
COVID-19 provider information
Wildfire Resources for Providers
Traditional health workers
Community
Community Giving at CareOregon
Community Giving grants for nonprofit organizations
Grant program recipients
Community Giving resources
Community partner resources
CareOregon in your community (Connect to Care)
COVID-19 vaccine resources
About us
Who we are
Board of Directors
Executive leadership
Partnerships and affiliations
What we do
Media requests and news
News and press releases
Careers
2020 Annual Report
Find a Provider or Pharmacist
Meds Chart
Careers
Contact us
Privacy policies
Menu
Not a
Member
?
I am a Provider
Learn More About Us
Providers
Provider support
Policies and Forms
Quality Metrics Toolkit
2020 important updates about OHP and metro-area CCOs
Provider updates
Language services
Physical health providers
Provider Portal
Provider Portal Tutorials
Metro area behavioral health providers
Pharmacy resources
MEDS Ed
Formulary List and Updates
Prior Authorization Criteria
Best practice guidelines
COVID-19 provider information
Wildfire Resources for Providers
Traditional health workers
Am I Eligible?
Find a Provider or Pharmacist
Meds Chart
Careers
Members
Providers
About us
Community
Contact us
Privacy policies
Classes and Events
Prior Authorization Criteria
Home
Providers
Pharmacy resources
Prior Authorization Criteria
Provider support
Policies and Forms
Quality Metrics Toolkit
2020 important updates about OHP and metro-area CCOs
Provider updates
Language services
Physical health providers
Provider Portal
Provider Portal Tutorials
Metro area behavioral health providers
Pharmacy resources
MEDS Ed
Formulary List and Updates
Prior Authorization Criteria
Best practice guidelines
COVID-19 provider information
Wildfire Resources for Providers
Traditional health workers
Menu
Provider support
Policies and Forms
Quality Metrics Toolkit
2020 important updates about OHP and metro-area CCOs
Provider updates
Language services
Physical health providers
Provider Portal
Provider Portal Tutorials
Metro area behavioral health providers
Pharmacy resources
MEDS Ed
Formulary List and Updates
Prior Authorization Criteria
Best practice guidelines
COVID-19 provider information
Wildfire Resources for Providers
Traditional health workers
Important:
Medical policies:
are not the same as medical advice and do not guarantee any results or outcomes or coverage. If you are a member, please talk about any health care questions with your health care provider.
do not determine benefits. Benefits and eligibility are determined before medical guidelines and payment guidelines are applied.
are interpreted and applied at the sole discretion of the Plan, and are subject to state and federal laws.
explain when certain medical services are medically necessary and whether or not they are investigational. For more information about medical necessity and investigational (research) criteria, please see these specific policies. Our coverage guidelines are written to cover a given condition for the majority of people. Each individual’s unique, clinical circumstances may be considered.
are based on constantly changing medical science. We reserve the right to review and update our policies periodically.
All documents revised June 1, 2022