General FAQ

For Providers

Are there any OHP members who will not transition to Health Share or another CCO?

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.

Have the benefits changed under Health Share?

No. Oregon Health Plan benefits stay the same under Health Share. Health Share offers the same services members have been getting.

How do I know in advance if a new member is pregnant or doesn’t speak English?

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

How do I reach someone in person with my questions?

You can contact Health Share Customer Service at 503-416-8090 or toll free at 888-519-3845. You can also email us at provider@healthshareoregon.org.

How do I submit claims?

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.

How do I write prescriptions or bill pharmacies?
  • 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.
I can’t tell what physical or mental health plan a member has. What should I do?

You can find both a member’s physical and mental health plan assignment in one location via Health Share’s provider portal.

What about my fee-for-service patients?

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.

Where can I learn more about health reform in Oregon and about CCOs?

You can visit the Oregon Health Authority’s website at www.health.oregon.gov.

Where do I submit prior authorizations?

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.

Copyright 2014 Health Share of Oregon · 503.416.1460 · 208 SW 5th Avenue, Suite 400, Portland, OR 97204

RSS Feed · Sitemap · Notice of Privacy Practices · Log in

Find us on Facebook
Find us on Twitter