Provider FAQs

Tri-County CCO Transition Information

All Health Share members seeking care should be referred to our online provider directory to find a provider within the Health Share Pathways Provider Network who can offer them timely care. If members want assistance finding a provider who meets their needs, they can call the member services number associated with their county of residence:

Clackamas County: 503-742-5335

Multnomah County: 503-988-5887

Washington County: 503-291-1155

 

If you have been seeing Health Share members without being approved to do so by the member’s respective Behavioral Health Plan Care Coordinator, services may not be reimbursed and, per OAR 410-120-1280, the member may not be billed.

If you have been seeing Health Share members without being approved to do so by the member’s respective Behavioral Health Plan Care Coordinator, services may not be reimbursed and, per OAR 410-120-1280, the member may not be billed.  Members seeking care should be referred to our online provider directory to find a provider within the Health Share Pathways Provider Network who can offer them timely care. If members want assistance finding a provider who meets their needs, they can call the member services number associated with their county of residence:

Clackamas County: 503-742-5335

Multnomah County: 503-988-5887

Washington County: 503-291-1155

Visit our Contracting with Health Share page on our website to request consideration to join the Health Share Provider Network.

In order to provide physical health services to Health Share members, you will need to contract with one or more of our four physical health plans.

·         CareOregon:  800-224-4840

·         Kaiser: 503-813-3376

·         Providence: PHPProviderContracting@providence.org

·         Tuality (Washington County Only):  Erin Blume: Erin.Blume@tuality.org  |  503-681-1688

Please review our Specialty Behavioral Health and Integrated Services Overview [SH1] document to determine if the services you offer are considered Physical Health or Behavioral Health.  If your services qualify as Specialty Behavioral Health, you can apply for a Behavioral Health contract with Health Share by visiting our Contracting with Health Share page on our website.  If your services qualify as Behaviorist Services, they fall under Physical Health and in order to provide physical health services to Health Share members, you will need to contract with one or more of our four physical health plans.

•          CareOregon:  800-224-4840

•          Kaiser: 503-813-3376

•          Providence: PHPProviderContracting@providence.org

•          Tuality (Washington County Only):  Erin Blume: Erin.Blume@tuality.org  |  503-681-1688


 [SH1]Link to new document “Specialty Behavioral Health and Integrated Services Overview.”

In order to provide Dental Health services to Health Share members, you will need to contract with one or more of our nine Dental Health Plans.

·         Access Dental Plan: 503-445-9056 or 877-213-0357

·         Advantage Dental Services: 866-268-9631

·         Capitol Dental Care: 503-585-5205 or 800-525-6800

·         CareOregon Dental:  503-416-1444 or 888-440-9912

·         Family Dental Care: 503-644-2663 or 1-888-350-0996

·         Kaiser Permanente Dental: 503-813-2000 or 800-813-2000

·         Managed Dental Care of Oregon: 503-581-1407 or 800-538-9604

·         ODS Community Health Dental Plan: 503-243-2987 or 800-342-0526

·         Willamette Dental Group: 503-952-2000 or 855-433-6825

Visit our Portal Registration page for more information about registering for the Health Share provider portal.

Providers shall notify Health Share of Oregon of any change to a Provider’s office or administrative address.  For changes to current office locations, or to add a new office location, please complete Appendix N1: Provider Office Address Update of the Provider Manual.  For changes to any administrative addresses (i.e., billing, mailing, credentialing), please complete Appendix N2: Provider Administrative Address Update of the Provider Manual. Once completed, the form(s) should be sent to providers@healthshareoregon.org.  Detailed instructions can also be found in the Pathways Provider Manual.

Currently contracted Organizational Providers who need to add a newly-hired and credentialed practitioner to their Health Share contract in order for claims to be processed correctly, must complete Appendix M: New Practitioner with Contracted Organizational Provider Form in the Provider Manual and send to provider.contracts@phtech.zendesk.com as well as providers@healthshareoregon.org. 

Prior to sending new practitioner information, Organizational Providers are responsible for credentialing their Practitioners in order to meet the Medicaid regulations stated in the Provider Manual. 

Detailed instructions can also be found in the Pathways Provider Manual.

Single Case Agreements are reviewed and approved or denied by our Behavioral Health Plan Care Coordinators.  You will need to call the number which you originally called to request the Single Case Agreement. 

Member eligibility must be confirmed using the OHA Medicaid Portal, MMIS.  More detailed information regarding logging into MMIS and checking member eligibility can be found in the OHP Provider Web Portal Eligibility Guide found on the OHA Provider Web Portal page.

If you do not have an MMIS account, follow OHP’s Account Setup Guide located on OHA’s Provider Web Portal page. 

 

Once you have determined that a patient is a Health Share member, you can use Health Share’s provider portal to locate additional member information, including eligibility dates and information regarding which behavioral, physical and dental health plans the member is assigned.

You will find information on pregnancy status and preferred language on Health Share’s Provider portal (CIM) when you check a member’s eligibility status.

Interpreter services are a covered benefit for Health Share Members at no cost to the Provider.  Consistent with the Participating Provider Agreement, Oregon Administrative Rules, and federal regulations, members have the right to receive information on available treatment options and alternatives presented in a manner appropriate to the member's condition, preferred language and ability to understand. 

Contact information for Behavioral Health interpreter services can be found in the Provider Manual.

Providers can find the Physical Health Plan to which a Member is assigned on the Member’s Health Share ID card, or in the Health Share provider portal (CIM).

If you do not have access to the Health Share provider portal, you can call the Health Share Customer Service at 503-416-8090 or toll free at 888-519-3845. 

 

Here is a sample of the member’s ID card where the Physical Health Plan can be found:

 

Providers can find the Dental Health Plan to which a Member is assigned on the Member’s Health Share ID card, or in the Health Share provider portal (CIM).

If you do not have access to the Health Share provider portal, you can call the Health Share Customer Service at 503-416-8090 or toll free at 888-519-3845. 

 

Here is a sample of the member’s ID card where the Dental Health Plan can be found:

A member’s behavioral health plan is based on the county in which they reside. Providers can find the county-based Behavioral Health Plan to which a Member is assigned on the Member’s Health Share ID card, or in the Health Share provider portal (CIM).  Providers may find contact information for each Behavioral Health Plan in the Regional Provider Manual, under “Plan Contact List.”

Here is a sample of the member’s ID card where the Behavioral Health Plan can be found:

Procedures for Prior Authorizations vary based on the type of contract you hold with Health Share.  Contact information regarding submitting prior authorizations to a specific Behavioral Health Plan can be found in our Provider Manual in the Plan Contact List.  If you do not know which type of contract you hold, please contact the Health Share contracting team at providers@healthshareoregon.org.

 

Physical health providers will continue to use Health Share’s plan partners’ provider portals pertinent to the member being served.

·         CareOregon: http://www.careoregon.org/Res/Documents/Providers/CO_Auth_Guidelines.pdf and http://www.careoregon.org/Providers/ProviderFormsandPolicies.aspx

·         Kaiser Permanente: http://www.providers.kaiserpermanente.org/html/cpp_knw/authorizationstoc.html?

·         Providence: https://healthplans.providence.org/providers/

·         Tuality Health: http://www.tuality.org/tha/index.php/provider_clinics/ohp_plans/ohp_referrals_and_authorizations or Phone: 503-844-8104  or  Fax: 503-681-1823

 

Providers may submit Claims by paper or electronically to Health Share’s Third Party Administrator, PH Tech. The preferred method of Claims submission is via Electronic Data

Interchange (EDI). 

EDI Payer IDs for accepted Clearinghouses

·     Payer ID for CORTEX EDI – HSOCC, CMHO1, CX034, or CX 032

·     Payer ID for GATEWAY EDI - VMMH1 or 16259

·     Payer ID for OFFICE ALLY –CCMMH, VMMH1, or WCHHS

·     Payer ID for RelayHealth – 77122

 

For questions on electronic Claims submission, please contact PH Tech’s EDI Team via email at editeam@phtech.com or by phone at 503-584-2169, option 1.

Paper Claims will be accepted on original copies of the current CMS (HCFA) 1500 Claim form. Photocopies of this form will not be accepted. Paper Claims may be mailed to:

Health Share of Oregon

PO Box 5490

Salem, OR 97304






Health Share members can have one of four physical health plans.  Providers must send a member’s physical health claims to the member’s respective physical health plan.   The four physical health plans are:

v  CareOregon: Electronic Claims: Payer ID#: 93975

Paper Claims should be mailed to:

CareOregon

PO Box 40328

Portland, Oregon 97240-0328

Visit Care Oregon’s website for more information regarding claims submission: http://www.careoregon.org/Providers/ProviderSupport.aspx

Kaiser Permanente: Electronic Claims Submission - Providers should access their clearinghouse to identify the Payer Id for Kaiser Foundation NW.

Paper Claims should be mailed to:

Kaiser Permanente National Claims Administration

PO Box 370050

Denver CO 80237-9998

Visit Kaiser’s provider manual for more information regarding claims submission: http://www.providers.kaiserpermanente.org/info_assets/cpp_knw/nw_section5-manual_0610.pdf 

v  Providence: Electronic Claims: Providers should access their clearinghouse to identify the Payer Id for Providence and can visit the Providence EDI website for more information: https://healthplans.providence.org/providers/provider-support/electronic-claims/

Paper Claims should be mailed to:

Providence Health Plans

Attn: Claims Processing

PO Box 3125

Portland, OR. 97208-3125

v  Tuality Health: Electronic Claims Payer ID#s:

Payer Connection:  THASC

Relay Health:  THA2012

Change Healthcare: 93112

 

Paper Claims should be mailed to:

Tuality Health Alliance

P.O. Box 925

Hillsboro, OR 97123

You can also call either 503-844-8106 or 1-866-575-8104 or visit Tuality’s website to learn how to submit electronic claims: http://www.tuality.org/tha/index.php/tuality_employees_and_families/submit_a_claim

 

All providers must submit all claims for mental health and substance use disorder (SUD) services within 120 calendar days of the date of service.

 

Exceptions to the 120 day timely filing rule include:

·         Eligibility issues such as retroactive enrollments or dis-enrollments; or

·         When Medicare or other third party resources are the primary payer.

 

Exceptions do not include failure of the provider to verify the member’s eligibility at the time of service.

When Health Share of Oregon is the secondary payor, the primary payor’s EOB is required and provider is allowed 365 calendar days from the date of service for claims submission.

Per OAR 410-120-1260 and CMS 42 CFR §431.52 and 42 CFR §447.15b all providers who receive payment for services rendered to Oregon Medicaid Members need to have their National Provider Identification (NPI) number enrolled in Oregon Medicaid for the dates of service. This includes NPIs for submitting, rendering, and the primary attending on a claim.

Enrollments are specific to NPI numbers and non-transferable. All NPIs which appear on a claim will need to be enrolled in order to be reimbursed for services rendered.

If you are unsure if you are enrolled in Oregon Medicaid, Providers may e-mail providers@healthhshareoregon.org to see if their NPI is currently enrolled in Oregon Medicaid.

 

Oregon Medicaid Enrollments are submitted to different plans, based on who is the responsible payer.

If the enrollment was submitted to a physical health plan for a physical health claim, you will need to contact the plan to whom it was submitted:

v  CareOregon: ProviderUpdates@careoregon.org

v  Kaiser Permanente: nw-medicaid@kp.org or Phone: 503-286-6839

v  Providence: Phone: (503) 574-7500 or (800) 878-4445

v  Tuality Health: alexis.underwood@tuality.org

 

If the enrollment was submitted to Ph Tech for a Behavioral Health Provider or Group, you will need to call Ph Tech at 503-584-2169, and select option 2.

The most current versions of Health Share’s Mental Health and Substance Use Disorder Fee Schedules can be found on the Behavioral Health Resources of the Health Share website.

If a member is covered directly by OHA, you can visit http://www.oregon.gov/oha/HSD/OHP/Pages/Billing.aspx for more information regarding billing for services rendered. 

Behavioral Health Providers should contact the Health Share Provider Contracting and Network Management team at 971-334-8056 or providers@healthshareoregon.org.

 

Physical Health Providers should contact the appropriate physical health plan(s):

Care Oregon: 503-416-4100 or CareOregonConnect@CareOregon.org

Kaiser: 503-813-2000

Providence: 503-574-7500

Tuality: 503-844-8104

 

Dental Health Providers should contact the appropriate dental health plan(s):

Access Dental Plan: 503-445-9056 or 877-213-0357

Advantage Dental Services: 866-268-9631

Capitol Dental Care: 503-585-5205 or 800-525-6800

CareOregon Dental:  503-416-1444 or 888-440-9912

Family Dental Care: 503-644-2663 or 1-888-350-0996

Kaiser Permanente Dental: 503-813-2000 or 800-813-2000

Managed Dental Care of Oregon: 503-581-1407 or 800-538-9604

ODS Community Health Dental Plan: 503-243-2987 or 800-342-0526

Willamette Dental Group: 503-952-2000 or 855-433-6825