2020 important updates about OHP and metro-area CCOs

Important updates about OHP and Health Share 2.0

PHYSICAL HEALTH

Transitioning members among Health Share partners

Throughout the Health Share 2.0 planning and transition process, CareOregon has been working closely with Health Share and the other health plan partners to minimize the impact of Health Share’s structural changes on our members and providers. However, as the changes have taken effect, Health Share’s member customer service is experiencing extremely high call volumes. Below, please see how you can help your members through this transition, as well as help them make changes to their health plan.

Please note:

Also, please remember:

• There is a 90-day period during which all claims for covered OHP services will be paid. Again, questions or uncertainty about payment should NOT result in a denial of service to OHP-covered members in the metro area.
  
  
• CareOregon will continue to contract with all the same hospitals and specialists in the region, including the Health Share Integrated Delivery System partners.
  
  
• Please do not cancel member appointments, regardless of the member’s current health plan assignment. All health plans are honoring existing physical health and pharmacy authorizations for up to 90 days, and specialty behavioral health authorizations for up to 180 days.
  
  
• Medicare members will remain in CareOregon’s unchanged Medicare network and will NOT change to different delivery systems (see detail below). Our dual-eligible members will continue to rely on quality primary care services at OHSU, Adventist, Legacy primary care clinics, Providence,  FQHCs and our other primary care partners.
  
  

If you have questions about your member eligibility files or the transition structure with Health Share in general, please contact Care Oregon’s Provider Customer Service at 800-224-4840, or contact your provider relations specialist directly. (If you don’t know who that is, please check our PRS Territory list.)

Additional important points:

1. There are NO CHANGES in how CareOregon is contracting with primary care for CareOregon Advantage (Medicare) members.

There are no changes in the CareOregon Advantage provider network for Medicare dual members. OHSU, Legacy, Providence and Adventist primary care networks for Medicare remain intact. Please help pass along the message that CareOregon Advantage duals will remain with their current PCPs, regardless of Medicaid IDS/ICN assignment, and their care should not be disrupted. Health Share will align their OHP-secondary provider assignment with their Medicare primary care provider.

2. OHP Health Share members with CareOregon should stay with their PCP, and their specialty network remains the same.

Beginning on January 1, 2020, Health Share OHP members whose primary care providers are affiliated with OHSU, Adventist,Tuality or Legacy were re-assigned to the new integrated delivery systems of OHSU Health or Legacy Health-PacificSource. Previous Providence members that were assigned to a provider other than Providence Medical Group and Children’s Health Alliance (including all of the FQHCs) were re-assigned to CareOregon. If CareOregon contracts with the member’s PCP, the member will remain with their PCP. If CareOregon does not contract with the member’s current PCP, we will work with the member to identify a new PCP within CareOregon’s network or help them change to another health plan.

CareOregon’s network of contracted specialists and hospitals has NOT changed, and members can continue to receive services from these providers.

3. Members can change their provider/health plan.

Understandably, members may be confused about being re-assigned to a new health plan. Please let them know they still have the option to change their health plan. If a member expresses a desire to change plans, please direct them to call Health Share customer service at 503-416-8090 or toll-free 888-519-3845. Please note, Health Share’s customer service staff is experiencing extremely high call volumes and some members are having difficulty getting through to an agent. If this is the case, you can direct members to call the health plan they’re currently assigned to and they can help the member initiate the change.

Alternatively, your staff can also help a member change their health plan. There are a couple of ways they can do that:

• A) You can complete a 2020 Physical Health Plan Change Request Form and submit to Health Share directly via secure email or fax. The IDS change will be retroactively made to the date indicated on the form. You do NOT need to follow-up with Health Share; the form is sufficient communication for Health Share staff to process the re-assignment.
• B) Contact your provider relations specialist or one of CareOregon’s Provider Customer Service staff and we will take the information and submit the 2020 Physical Health Plan Change Request Form to Health Share on your behalf.
  
  

4. Always check your system for the most accurate eligibility information.

Some members have been assigned to a new health plan incorrectly. As mentioned above, Health Share is working to resolve these issues. However, in some cases, members are currently assigned to the correct primary care provider and health plan, but due to the timing of needing to mail the ID cards, the ID card is incorrect. So, before you work with the member to change their health plan, please check their current eligibility in the system first.

We appreciate your patience as we work to transition Health Share members among the partner health plans. More information about the transition can be found on Health Share’s website.

BEHAVIORAL HEALTH

Health Share’s Specialty Behavioral Health benefit transitioned to CareOregon as of January 1, 2020. If you have any questions about referring your members into specialty behavioral health, please contact Provider Customer Service at 503-416-4100 or toll-free 800-224-4840. For those of you that provide specialty behavioral health services, there is detailed information about the benefit transition on our Behavioral Health page.

Our goal is to facilitate a seamless transition without disruption to providers and members. No significant changes are intended to be made to the provider network during this transition and, with very few exceptions, new contracts and service authorizations have been put into place with the pre-existing Health Share Pathways Provider network to assure a seamless transition for members.

DENTAL HEALTH

As part of the Health Share 2.0 restructure, members that were not previously engaged with a dentist may have been assigned to a new Dental Plan. Dental Plan assignments can be found in CIM. If a member has a question about their dental plan assignment or wants to make a change, have them contact Health Share Customer Service at 503-416-8090 or 888-519-3845. If your member has difficulty getting through because of Health Share’s unusually high call volume, have them contact CareOregon Member Customer Service at 503-416-4100 or 800-224-4840.

MEDICAL TRANSPORTATION

In 2020, the non-emergent medical transportation program, which we sometimes call NEMT, will be administered by CareOregon. But most things are not changing – the benefit itself will stay the same. Ride to Care should still be contacted at 503-416-3955 to request transportation services.

Please save this page and continue to check back for more information in the months to come.