Yes. Tribal clients who do not wish to be enrolled in a health plan; clients who have both Medicare and Medicaid coverage and do not wish to be enrolled in a CCO; CAWEM and CAWEM-Prenatal clients; and clients with third party liability.
No. Oregon Health Plan benefits stay the same under Health Share. Health Share offers the same services members have been getting.
You will find information on pregnancy status and preferred language on Health Share’s portal when you check a member’s eligibility status.
You can contact Health Share Customer Service at 503-416-8090 or toll free at 888-519-3845. You can also email us at firstname.lastname@example.org.
You will submit your claims the same way as you have always done, sending them directly to the health plan for physical health claims.
If you are a community mental health service provider, you will not need to do anything. PH Tech’s claim services will automatically roll all existing authorizations under the new Health Share of Oregon name.
- You will write prescriptions as you have always done. The formulary has not changed. The Pharmacy Benefits Manager (PBM) has not changed.
- Mental Health Drugs (7-11 drugs): Bill the state as you have always done.
You can find both a member’s physical and mental health plan assignment in one location via Health Share’s provider portal.
Fee-for-service members are being phased into Coordinated Care Organizations. Most OHP clients who currently receive care through fee-for-service are being transitioned to their local CCO.
You can visit the Oregon Health Authority’s website at www.health.oregon.gov.
The new portal does not affect how claims or prior authorizations regarding Health Share members are submitted. Physical health providers will continue to use Health Share’s plan partners’ provider portals pertinent to the member being served. Clackamas, Multnomah and Washington Counties will continue to use a separate version of PH Tech’s CIM web portal to manage behavioral health authorizations and claims payment. Existing users of that system can use the same username and password for the new Health Share provider portal site.
You DO NOT have to resubmit any of your patients’ already APPROVED prior authorizations that cover 2012 or any period between August 1 and December 31, 2012, for either physical or mental health authorizations. We will take care of this for you.