Q. Will I have to get new authorizations to replace my existing ones?
A. No. Existing authorizations will be honored through their end date.
Q. How do I request an authorization?
A. Please continue to follow the current process.
Q. Who will conduct utilization/concurrent review for services needing an authorization?
A. As of Dec. 18, 2019 CareOregon has taken over the review process.
Q. What medical necessity decision making tool will CareOregon be using for authorization decisions?
A. CareOregon will be using Interqual for medical necessity decision making. The current Pathways Level A-D levels of care criteria for outpatient Mental Health will also be in place with no changes to the current clinical criteria.
Q. How does an authorization work when a member is in WRAP services and a level of care is
recommended by the WRAP team?
A. CareOregon will honor authorization requests from WRAP teams as part of the member’s plan of
care. These services will be reviewed for medical necessity and approved as a benefit exception if
criteria are not met.
Q. What will the length of the initial SUD residential authorization be? What will the length of ongoing authorizations for SUD residential extended admissions be?
A. There will be no change. This will remain in its current state.
Q. What will the length of the initial medically monitored SUD residential authorization be? What will the length of ongoing authorizations for medically monitored SUD residential extended admissions be?
A. There will be no change. This will remain in its current state.
Q. Can authorization be approved for a Level D spot without having to put a client in a contracted ICM spot?
A. Yes, for providers who have Level D services in addition to ICM programs.
Q. Will our fee schedule be posted on the CareOregon website?
A. The fee schedule will be posted on the PhTech/CIM site. Providers with access can access the fee
schedule through that portal.
Q. Are there changes to the level of care form? Does CareOregon require that it to be included in the clinical record?
A. There are no changes to the form or procedures at this time.
Q. Can I download fee schedules?
A. Yes. They can be downloaded via CIM.
Q. If a patient has Kaiser Health Share for physical health, but CareOregon for mental health, and we hold a contract with CareOregon for behavioral health but do not hold a Kaiser Health Share contract, are we able to still see the patient for mental health services?
A. Yes. CareOregon will handle the authorizations and claims for all Health Share members, including
members assigned to one of the integrated delivery systems of Health Share such as Kaiser or Providence.
Q. Is there one central email to submit forms? HSTAR emails? Right now we email HSTAR to
ASOC for Multnomah County, and fax HSTAR for Clackamas County. Is there going to be one central email to submit HSTAR?
A. CareOregon has new forms that replace the HSTAR. All requests, regardless of county, will be processed by one centralized team within CareOregon.
Q. Will authorization requests go through CIM or the CareOregon portal we currently use for JCC, CPCCO or CareOregon Advantage (Medicare) authorizations?
A. Specialty behavioral health authorizations for Health Share members will be managed in CIM and all other authorizations related to other CareOregon lines of business will remain in our other portal, CareOregon Connect..
Q. Will authorizations roll over from the counties to CareOregon?
A. Yes.