Provider support

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.

Please call Provider Customer Service at 503-416-4100 or 800-224-4840. Press option 3 for provider.

 

Care Management Department

Fax: 503-416-3637 or 800-862-4831

 

Verifying clinics’ email addresses

CareOregon is confirming clinics’ email addresses to ensure we can contact you with system alerts and other critical information. Please send the email address(es) that you want CareOregon to use when contacting your clinic to careoregonalerts@careoregon.org. Be sure to identify each email with a name and job title.

 

Need to change your clinic info?

Send changes or updates to providerupdates@careoregon.org.

 

Provider relations specialists
View our team assignments list to find your specialist. Fax us at 503-416-1478 or 800-874-3916.

CareOregon provides plan services to three Coordinated Care Organizations (CCO) and offers a Medicare Advantage plan supporting and enhancing sensible, localized, coordinated care.

If you are interested in becoming a contracted provider, please review our credentialing requirements (outlined in our CareOregon Provider Manual).

If you have additional questions, or would like to learn more about requesting consideration for a contract, please contact Customer Service at 800-224-4840 or 503-416-4100. You may also complete the New Contract Requests form here. Please be certain to include all applicable fields for consideration.

Thank you for your interest in joining CareOregon’s provider panel!

CareOregon helps you coordinate interpreters for patients who prefer or need a language other than English. Please  click here for resources, including forms to request interpreting services, a language ID tool for your facility, “I speak” cards, and more.

When members have health needs that aren’t covered by a health plan or other services, CareOregon offers funds for health-related services (HRS). HRS must be consistent with a member’s treatment plan, as developed by their primary care team or other treatment providers. The services will be documented in the member’s treatment plan and clinical record. For that reason, members without a current provider relationship need to establish one in order to receive health-related services funds.

Providers who would like to learn more about the basic framework of Health-Related Services flex process, regulatory requirements and how to access this resource, please watch this webinar by clicking here. 

What HRS covers

These funds cover items or services that aren’t covered under standard health plan services, but will improve a person’s health. Health plans cover provider visits, pharmacy benefits and durable medical equipment. Durable medical equipment (DME) is a covered benefit, which means equipment that would be covered as DME is not eligible for HRS funds. (For a list of items covered by DME with no authorization required, click here.)

Health-related services funds cover services like:

  • Helping a person get a cell phone if having one will give them better access to their providers.
  • Transit passes for members who need transportation for health-related needs beyond covered appointments.
  • Buying an air conditioner for a person whose health is affected by the warmth and airflow in their home.
  • Vouchers for a yoga studio for a person whose back pain will be helped by an exercise class.
  • A class on cooking healthy meals for a person with diabetes.

This is not an exhaustive list. Any requested items will be evaluated for consistency with a member’s health needs and treatment plan.

 

Requesting HRS funds

Limitations of health-related services: The Oregon Administrative Rules restrict health-related services to items not paid for with grant money, funding separate from CCO contract revenue, or normal clinical service billing. In other words, health-related services may be used only if other funding is not available. Before you make a request, please be sure there is no other funding available.

Making a health-related services request: Any health care provider, primary care team, care coordination staff member working directly with members, or other subcontractors of CareOregon’s network may request the use of HRS for a member. CareOregon encourages our community-based organization (CBO) partners to help our shared members access HRS. CBOs can work with members and their treatment providers to identify the need, and the provider can submit a request.

All HRS requests must include medical documentation (care plan, progress notes, chart notes, etc.) and information about the member’s diagnosis.

There are two ways to submit requests for health-related services:

  1. Use our standard Health-Related Services Flexible Services Funding Request form to make requests for cell phones, hotel rooms or other health-related services for individual members:
    • Items that are needed on a repeating basis — like monthly transit passes or gym memberships, extensions of hotel stays, etc. — require the submission of a Funding Request form each month.
    • Urgent requests will be fulfilled in two to five business days. Standard requests will be fulfilled in 10-14 business days. Please see the  form instructions for more information.
    • For K Plan Letter requests, please  click here.
    • For hotel stays, click here to download our hotel liability form that members must fill out and click here to download our hotel request checklist.
    • If a member lives in an area being impacted by a current state of emergency and needs a hotel, our State of Emergency Flex Request may be the quickest way to assist the member. Please see the instructions for more information.
  2. Bulk items are available to help clinics and providers ensure a constant supply of the following items:
    • Cell phones and phone minutes
    • Transit passes
    • Sleeping bags
    • Shelter materials (tents and tarps)
    • City Team shelter vouchers
    • Personal hygiene products
      • This includes (but is not limited to) shampoo, conditioner, body and face washes, soap and feminine hygiene products
      • Some items are not included, like (but not limited to) PPE, incontinence supplies, diapers, sunscreen, sanitary wipes, disinfectant wipes, thermometers, durable medical equipment (DME) or COVID-19-specific items, as described above
    If these bulk items are purchased by providers/clinics, you must submit a Bulk Request Tracking document and itemized invoices to be reimbursed. To request that items be purchased by CareOregon (and then delivered to providers or clinics), fill out our Bulk Purchase Request form.
    • Bulk requests may take up to 14 business days for review and delivery.
    • Clinics and county teams may make bulk requests one time per month.
    • Requests should be submitted by supervisors or managers.
    • Clinics/teams are required to submit a Bulk Request Tracking document with member details before new orders can be fulfilled. 
 

Evaluating requests

CareOregon evaluates all completed request forms based on:

  • The member’s eligibility and whether the request fits their treatment plan.
  • A sustainability plan to support the member’s ongoing needs, because CCOs may not be able to support these needs in the long term.
  • Whether other community resources or safety net funds (besides HRS) were pursued before the request was made.

We provide members with a written outcome and copy the requesting provider (and member representatives, if applicable). Often, this involves asking for more information about the member, which may include the member's budget information. Requests cannot be fulfilled until all information is received.

Depending on the nature of the request, if more details about the budget is indicated, this form can be used to provide that information.

Questions? Email us at social.determinants@careoregon.org.

What is a Regional Care Team?

CareOregon Regional Care Teams (RCTs) offer providers a community of resources with a single point of contact for you and your patients. RCTs work closely with providers and members – through both telephonic and community-based support – to smooth the way to better care and better outcomes. Click here to view our Regional Care Team overview in PDF format.


Our purpose

With care coordination through RCTs, we will deliver the right care, at the right time, in the right place, with the right team.

Members will have a consistent care team that will collaborate across disciplines to develop and implement a member-centric care plan through telephonic, electronic or community-based interventions to resolve identified needs and promote healthy outcomes.

Each RCT is made up of care coordinators with a variety of backgrounds and experience, including:

  • Nursing
  • Behavioral Health
  • Substance Use Disorders
  • Pharmacy
  • Health system navigation
  • Local community resources
  • And others

 


How do I make a care coordination referral?

Online: Submit a completed Care Coordination Referral form and we’ll route it to your assigned RCT.

Email: Send us a completed form to ccreferral@careoregon.org.

Collective (PreManage): If your clinic uses this online platform, check the RCT tag after searching for your patient.

Call: Check the list below to see where your clinic is assigned, and call that number.

Not sure which RCT to contact? Call our general care coordination line at 503-416-3731 or Customer Service at 503-416-4100 and we’ll connect you to your assigned team.


How RCTs are structured

CO-1967745-provider RCT image

 

Find your local RCT


Regional Care Team

Region / Clinic System

Phone number

Steel

Washington County

OHSU Clinics
House Call Providers

503-416-3727

 

Abernethy

Clackamas County
Adventist Clinics

503-416-3729

 

St. Johns

Multnomah County - west of I-205

503-416-3726

 

Tilikum

Multnomah County - east of I-205

503-416-1770

 

Sellwood

Maternal Child Health
Pediatric Clinic
Foster Care Youth
503-416-3768

Burnside

Central City Concern503-416-3657

General/Unassigned

No RCT Assignment
or Unknown

503-416-3731

 

Download a PDF summary of this information here.

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 you are eligible icon

See if they're eligible for Medicare and help you enroll in the Oregon Health Plan

appointments

Help set up their medical, dental and behavioral health appointments

ID cards

Order replacement Member ID cards

connect to staff

 

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. 

How to submit claims

When submitting claims to CareOregon, you have several options:

  • Send claims electronically using our payer ID 93975. Please contact Change Healthcare at 877-363-3666 for more information.
  • Mail paper claims to:
    Claims, CareOregon
    PO Box 40328
    Portland OR 97240

Please note:

Send electronic claims to payer ID (93975). Send CareOregon Advantage and OHP electronic claims to the same payor ID (93975). Do not bill separately for each plan.

 

Electronic HIPAA transactions

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.

  1. 1. Enroll with CareOregon for ACH direct deposit payment directly, at no cost.
    Please complete this EFT-PDF form and fax back to the number listed on the bottom of the form
  2. 2. Enroll with Zelis Payments for ACH direct deposit payment or virtual credit card for a small fee. To enroll with the Zelis Payment network, go to their website at https://www.zelis.com/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:

 

To submit claims electronically:

  • 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.

 

Information on filing claims and pricing

See Also:

 

Claim inquiries

You have several options:

  • Send your emailed claims inquiries to claimshelp@careoregon.orgNote: All emails containing protected health information (PHI) must be sent in a secure manner. We are unable to respond to emails that are not sent securely.
  • Call: 503-416-4100 or 800-224-4840. Press option 3 for provider.
  • Fill out the Provider Claim Appeal form.

Training documents  can be found here.

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.

Model of Care Training presentation for providers

Training documents can be found here.

If you have questions please contact Melodie Farmer Quality Assurance Program Manager, Medicare Population Health Partnerships at farmerm@careoregon.org or 503-416-4631.

Quality Metrics Toolkit

2022 CareOregon Quality Metrics Toolkit - all measures (Updated June 2022)

  • Model of care training: Presentation (PPTX) | Attestation