As a CareOregon provider, you may have specific questions for us. Below, you’ll find contact and procedural information for providers. If you are looking for specific forms and policies, visit our provider page and select your area. Please click on a topic below to get started.
Find the most convenient way to contact us, update your clinic information and sign up for updates from CareOregon.
Please call Provider Customer Service at 503-416-4100 or 800-224-4840. Press option 3 for provider.
Becoming a CareOregon provider
Thank you for your interest in joining CareOregon’s provider panel!
CareOregon administers plan services for three Coordinated Care Organizations (CCO) and a Medicare Advantage plan (D-SNP), supporting and enhancing sensible, localized, coordinated care.
If you are interested in becoming a contracted provider, please review our credentialing requirements to ensure you meet the qualifications. Credentialing requirements are outlined in our provider manuals:
If you meet credentialing requirements and would like to be considered for a contract or have additional questions, please complete the Contract Requests form here. CareOregon is committed to improving health equity by reducing health disparities historically associated with characteristics commonly linked to discrimination or exclusion.
- Information about the provider’s race, ethnicity, and cultural linguistic capabilities.
- The availability of auxiliary aids and services for all members with disabilities, upon request .
- Whether providers have verifiable language fluency in languages other than English.
Help our members and potential members get the right care and service they deserve, in a language they understand. From signing up eligible candidates to finding them a free air conditioner when it gets hot, you can find resources to provide the best service in the menus below.
CareOregon helps you coordinate interpreters for patients who prefer or need a language other than English. Please visit our Language services page for resources, including forms to request interpreting services, a language ID tool for your facility, “I speak” cards, and more.
CareOregon Regional Care Teams (RCTs) offer providers a community of resources with a single point of contact for you and your patients. To learn more about these resources, visit our Care Coordination services page
CareOregon Connect to Care
What is Connect to Care? And how can it help your patients?
We all know that Medicaid and the Oregon Health Plan (OHP) can be complicated, but we’re here to help make it easier for current and prospective members. How do we do that? With Connect to Care, CareOregon’s community outreach program.
You might have seen or heard of Connect to Care before, when it was called goMobile. But we changed the name so that it’s easier to understand what we’re all about – connecting people with the care they deserve.
Every month, Connect to Care comes out to the communities where your patients live, all over the Metro area – including Clackamas, Multnomah and Washington counties. We find out if they have Medicaid, and if they don’t, we can help them get signed up for it through the Oregon Health Plan. That means they can get physical health care, but also dental and mental health care, too.
And if they already have health insurance through OHP, we can help them manage their health care.
There are lots of things Connect to Care and our partners are here to help your patients with:
See if they're eligible for Medicare and help you enroll in the Oregon Health Plan
Help set up their medical, dental and behavioral health appointments
Order replacement Member ID cards
Connect them with trained staff to help coordinate their health care needs
Connect to Care goes out to locations all over the Metro area. Where will we be next? Find out here or call our Customer Services at 503-416-4100 or toll-free 800-224-4840.
Submitting claims and receiving payment
You can find instructions and options for various methods of submitting claims, receiving payments and remittance advices.
When submitting claims to CareOregon, you have two options:
- Send claims electronically using our payer ID 93975.
- Mail paper claims to:
- Claims, CareOregon
PO Box 40328
Portland OR 97240
- Claims, CareOregon
To submit claims electronically:
- Use the same EDI Payer ID #93975 for all CareOregon entities (CareOregon Dental, CareOregon Advantage and CareOregon Medicaid claims). Do not bill separately for each plan.
- For EDI claims for which additional paperwork or documentation will be submitted, complete this form and indicate submission in the PWK segment (Loop 2300).
- Contact your practice management system vendor or clearinghouse to initiate electronic claim submission. CareOregon accepts HIPAA-compliant 837 electronic claims through our clearinghouse, Change Healthcare. Change Healthcare will validate the claims for HIPAA compliance and send them directly to CareOregon. Change Healthcare offers several solutions for providers without a practice management system or clearinghouse. Contact them at 866-369-8805 for medical claims and 888-255-7293 for dental claims.
The AMA recognizes electronic health care transactions as a cost saving, efficient way to do business and allows physicians to refocus resources on patient care. The links below provide information regarding various electronic transactions such as submitting claims, receiving payments and remittance advices.
To access your remittance advice electronically:
To receive payments via Electronic Funds Transfer (EFT):
CareOregon provides a couple of options for electronic payment.
- Enroll with CareOregon ePayment Center, administered by Zelis for ACH direct deposit payment, at no cost. Please contact the ePayment Center customer service team at 855-774-4392 or firstname.lastname@example.org for instructions on how to register and enroll. Please note, TIN verification is required for registration and enrollment.
- Enroll with Zelis Payment Network for ACH direct deposit payment or virtual credit card for a small fee (this is separate from CareOregon’s free ePayment ACH option noted above).
To enroll with the Zelis Payment Network, go to their website at https://www.zelis.com/providers/provider-enrollment/,
or you can call them at 855-496-1571.
- Please note: CareOregon is not involved in any relationship with providers and Zelis Payments. It is strictly between Zelis and you, the provider.
To receive electronic remittance advice:
- 835 form: Please complete and fax back to the number listed on the bottom of the form
- 835 information guide
- Important: 835 enrollment is available through CareOregon ePayment Center, administered by Zelis. If enrolling with the ePayment center, please do not submit this form. Instead, select the option for 835 enrollment upon registration through the ePayment center.
- Portal (24/7 access) for claims, authorizations, remittance, etc.
- Call Customer Service 800-224-4840, option 3
- Send us a secure email for larger inquiries at email@example.com
Stay up-to-date on quality metrics, fraud waste and abuse policies, and Model of Care training with the following tools.
CareOregon takes fraud, waste and abuse very seriously. If you suspect that benefits aren't being used correctly or want to report a case of waste, abuse or fraud, please contact Ethics Point at 888-331-6524. You also can file a report online at www.ethicspoint.com.
Providers should report any instance of FWA to CareOregon within three (3) days of discovery.
Providers must complete training designed to educate on ways to prevent, detect, and correct instances of FWA.
- Training must align with the materials presented in:
- CMS Medicare Learning Network (Medicare Fraud & Abuse: Prevent, Detect, Report WBT (cms.gov)s).
- Coordinated Care Organization contract with the Oregon Health Authority (Exhibit B, Part 9, Section 11).
- Special Needs Plan Model of Care Training – Provider Module
- If you have questions, please contact:
Director, Care Coordination
- Please complete and submit the following Model of Care Clinic/Practice Attestation once you’ve completed the training.