OHSU Health Services Provider information and benefit tracker Information about medical eligibility, benefits, claims and referral information. Information and resources How to use the Auto Auth Application Use the Auto Auth Application How-to Guide to navigate the new program. If you have a question not covered in the FAQ, call Medical Customer Service for further assistance at 844-827-6572 . Prior Authorization Guidelines OHSU Health Services Referral and Authorizations OHSU Health Complete Prior Authorization List OHSU Health Services Injectable Medication Prior Authorization List OHSU Health Services Injectable Medications Post Services Claim Edits Program OHSU Health Services PET scan approval OHSU Health Services EPSDT Prior Authorization list for members age 20 and under EviCore Prior Authorizations EviCore: Cardiovascular & Radiology | EviCore by Evernorth Once there, type in "OHSU Health Services" to locate plan-specific guidelines. OHSU Health Services eviCore Cardiology Prior Authorization list OHSU Health Services evicore Advanced Imaging Prior Authorization list Once there, type in "OHSU Health Services" to locate plan-specific guidelines. OHSU Health Services eviCore Cardiology Prior Authorization list OHSU Health Services evicore Advanced Imaging Prior Authorization list eviCore prior authorizations for services, May 1, 2026, and after OHSU Health Services eviCore Genetic Testing OHSU Health Services eviCore Joint Surgery OHSU Health Services eviCore Pain Management OHSU Health Services eviCore Spine Surgery OHSU Health Services eviCore Therapies and Chiropractic Provider resources Provider manual (April 2026) Flexible Services Request Form Safe Beginnings Flexible Funds Request Form Interpreter Services Request Form Care Management Referral Form Health Share of Oregon Physical Health Plan Change Request Form Provider Inquiry and Appeal Form Recuperative Care Program Request Form Sapphire Gateway Request Form TridentCare mobile imaging and lab services request form Birth doula services and traditional health workers Doula care is a covered benefit for OHP members. The benefit package includes two visits before delivery, support during delivery, and two visits after delivery. OHSU Health IDS promotes the use and inclusion of licensed/certified traditional health workers, including peer support specialists, peer wellness specialists, personal health navigators and community health workers. OHP members do not need a referral to work with a traditional health worker. Ride to Care information NEMT: Ride to Care Visit Health Share's page for helpful tools, including a hospital discharge form.. Contact information: Regular business hours: 8 a.m.-5 p.m., Monday through Friday, except holidays. Portland metro area: 503-416-3955 , icaltransportation@careoregon.org Visit Health Share's page for helpful tools, including a hospital discharge form.. Contact information: Regular business hours: 8 a.m.-5 p.m., Monday through Friday, except holidays. Portland metro area: 503-416-3955 , icaltransportation@careoregon.org Regular business hours: 8 a.m.-5 p.m., Monday through Friday, except holidays. Portland metro area: 503-416-3955 , icaltransportation@careoregon.org Pharmacy prior authorization and formulary Printable formulary Formulary updates Medication authorization request Prior authorization guidelines Step therapy guidelines Prior authorization for provider-administered drugs Alpha-1-Proteinase Inhibitors Bortezomib (Velcade) Fosaprepitant IV Leuprolide depot Paclitaxel Albumin Bound Rituxan Hycela SQ Sandostatin LAR Zolendronic acid Pre-payment claims edit to diagnosis criteria and criteria for maximum units. Prior authorizations do not apply for this policy. Fosaprepitant IV Aducanumab (Alzheimer's disease) Allergy Blood Testing Anesthesia for Endoscopic Procedures Balloon Dilation of Eustachian Tube Knee Cartilage Transplants Mobile Outpatient Cardiac Telemetry (MOCT) Push Rim-Activated Power-Assist Device for a Manual Wheelchair Serum Antibodies for Diagnosis of Inflammatory Bowel Disease Skin and Tissue Substitutes Therapeutic Drug Monitoring Treatment or Removal of Benign Skin Lesions Vagus Nerve Stimulation (VNS) Vitamin D Testing Policy Evidence-based practice guidelines The following clinical practice guidelines are intended to support our health care providers and serve as resources to ensure our providers have relevant, evidence-based information about our adopted standards of care. As part of Health Share of Oregon, the following guidelines apply to our OHSU Health IDS provider network. Health Share of Oregon Clinical Practice Guidelines OHSU Health IDS also has adopted the following evidence-based practice guidelines: Advance care planning Breast cancer screening Bright Futures immunization schedule Cervical cancer screening: U.S. Preventive Taskforce Women's Preventive Health U.S. Preventive Taskforce Women's Preventive Health Diabetes care (based on ADA guidelines) Please note: The ADA Diabetes guideline makes recommendations for certain treatments that are not covered benefits under the Oregon Health Plan (OHP). The IDS has adopted the ADA guideline for diabetes only for services covered by OHP. IDS endorsement of this guideline does not make services or treatments that are not covered benefits under OHP available to IDS members Please note: The ADA Diabetes guideline makes recommendations for certain treatments that are not covered benefits under the Oregon Health Plan (OHP). The IDS has adopted the ADA guideline for diabetes only for services covered by OHP. IDS endorsement of this guideline does not make services or treatments that are not covered benefits under OHP available to IDS members Sepsis diagnosis and initial management Health Related Social Needs (HRSN) Benefits OHSU Health Service members experiencing specific life transitions may be eligible for free devices and housing support to help create a healthier living environment. Who is eligible for the HRSN benefits? This HRSN benefit targets specific populations among OHP members experiencing life transitions. They must also have a qualifying medical need. Visit Oregon Health Authority’s website for details about qualifications. Not all OHP members will be eligible. What does the HRSN Nutrition Support benefit provide? Eligible members who have a qualifying medical health need related to nutrition can get nutrition education, medically tailored meals, pantry stocking and/or fruits and vegetable benefits. These benefits do not provide for general food insecurity. What does the HRSN Housing Support benefit provide? Rental assistance, like rental payments, deposits, utility assistance for up to 6 months Medically necessary home modifications, like ramps, handrails, environmental remediation Tenancy support services, like eviction prevention, housing case management What does the HRSN Housing benefit NOT offer? Temporary or other housing for people who are currently houseless or experiencing homelessness Emergency shelter needs Mortgage support What does the HRSN Home Changes for Health benefit provide? Air conditioners

Air filtration devices Mini refrigeration units Portable power supply Portable/space heaters To apply for HRSN nutrition or housing benefits: Send a request online to CareOregon: Social Needs Request Form Call CareOregon Member Customer Service: 503-416-4100 Press option 1 for member, then select option 6 for social needs. Press option 1 for member, then select option 6 for social needs. Email: HRSNCX@careoregon.org Fax: 503-416-1376 CO Housing Request Form (PDF) CO Nutrition Request Form (PDF) To apply for HRSN Home Changes for Health benefit: Send a request online Call Customer Service for additional help: 844-827-6572 More information: Health Share of Oregon HRSN Oregon Health Authority HRSN Advance directives Visit OHA's website for forms in multiple languages and an overview of advance directives. Oregon State Agency Requested Medical Records: Anytime an Oregon state agency is requesting medical records, they will provide one of two forms to providers. If the patient is an Oregon Health Plan member on the date of service, the agency will provide Form 729 which allows the provider to bill the Division of Medical Assistance Programs for the cost of medical record copying charges (and mailing if applicable). In order to be paid by DMAP, the provider must complete an HCFCS 1500 and attach Form 729 for the claim to be processed by DMAP. While the form offers a physical mailing address as a means to submit these forms, it is more efficient (and trackable) to submit using the EDI portal (the same portal used to process Open Card submissions). Questions about the portal should be directed to DMAP Provider Relations at 800-336-6016. If the patient is not an Oregon Health Plan eligible member on the date of service, the agency will provide Form 501A which allows the cost of the medical record copying charges (and mailing if applicable) to the Oregon General Fund (through the agency requesting the records). Contact Provider Relations Call 503-418-7750 or email ohsuhealthprvrelations@ohsu.edu . Compliance guides and attestation forms Training materials - attestations were due July 1, 2026 2026 Fraud, Waste and Abuse Compliance Training Booklet 2026 Attestations form Policies and guidelines OHSU Health IDS Code of Conduct and Conflict of Interest OHSU Health IDS Ethics and Compliance Program OHSU Health IDS Fraud, Waste and Abuse Handbook Cultural Competency The Oregon Medical Board requires cultural competency training for all new medical licenses and for all renewing providers. Starting in October 2021, providers must demonstrate on initial and renewal application for credentialing that they meet the state requirements by submitting proof of completion of the training in cultural competency. Many different types of courses and experiences meet the cultural competency continuing education requirement including experiential or service learning, cultural or linguistic immersion, volunteering in a rural clinic, courses approved by the Oregon Health Authority and more. Cultural Competency training discount for OHSU Health IDS network providers through Oregon State University College of Pharmacy OHSU Health IDS providers can receive a 25% discount for this Oregon Health Authority-approved training, regularly priced at $60 per student. Find details in this letter . All Healthcare Providers - $15 off - use promo code OHSUCCALL15 (All-Providers) OBMI/ARRT - $15 off - use promo code OHSUCCOBMI15 (OBMI/ARRT) Pharmacist/Technician - $15 off - use promo code OHSUCCACPE15 (ACPE) CME - $10 off - use promo code OHSUCCCME10 (ACCME) Below are some additional resources to help you locate cultural competency continuing education opportunities. For questions regarding the cultural competency requirements, email OHSUHealthPrvRelations@ohsu.edu . Oregon Medical Board Cultural Competency Oregon Health Authority Cultural Competence Continuing Education Coding and documentation education resources Questions about HCC coding? Contact us Nonemployed clinicians: OHSUHealthHCC@ohsu.edu OHSU and HMC clinicians: HCCteam@ohsu.edu OHSU Health 2026 Coding Education Webinars 2026 dates: All meetings 8 - 9 a.m. 01/20/26 - ICD-10-CM Coding and Documentation for Chronic Diagnoses 02/17/26 - ICD-10-CM Documentation and Coding for Neoplasms 03/17/26 - ICD-10-CM Documentation and Coding for MI and Heart Disease 04/21/26 - ICD-10-CM Updates and Hot Topics 05/19/26 - ICD-10-CM Documentation and Coding for Acute Conditions - Sepsis, Stroke, etc. 06/16/26 - ICD-10-CM Documentation and Coding for Kidney Disease 07/21/26 - ICD-10-CM Documentation and Coding for Allergy and Respiratory Diagnoses 08/18/26 - ICD-10-CM Documentation and Coding for Connective Tissue and Rheumatoid Diagnoses 09/15/26 - ICD-10-CM Updates and Hot Topics 10/20/26- ICD-10-CM Documentation and Coding for MS, CP and Neuromuscular Diagnoses 11/17/26- ICD-10-CM Documentation and Coding for Vascular Diagnoses 12/15/26 - ICD-10-CM Documentation and Coding for Diabetes To sign up for webinars , please contact Monique Vanderhoof at vandermo@ohsu.edu . Reminder: The OHSU HCC team is an excellent education resource; however, they should not be the point of contact for HCC questions for nonemployed network members. Behavioral health interventions for young children Z codes ICD-10 Z65.5 (Exposure to disaster, war and other hostilities) Allows for domestic medical screenings for newly arrived refugees. When billing Oregon Health Plan, list Z65.5 as the primary diagnosis on claims for domestic medical screenings. List other diagnosis codes, as appropriate, in secondary positions. Allows for domestic medical screenings for newly arrived refugees. When billing Oregon Health Plan, list Z65.5 as the primary diagnosis on claims for domestic medical screenings. List other diagnosis codes, as appropriate, in secondary positions. OHP and OHSU Health forms Below are forms and links you may need. HCPC codes for Ostomy and Urological Supplies - Updated Appeal and Hearing Request Client Agreement to Pay Consent to Sterilization​ (ages 21 and over) Consent to Sterilization (Ages 15-20) Denial of Medical Services Appeal and Hearing Request Guide to Oregon’s Declaration for Mental Health Treatment Hysterectomy Consent OHSU Health Member Authorization Allowing Healthcare Provider to Use/Disclose Protected Health Information OHSU Health Services Complaint OHSU Health Services Nondiscrimination Notice 2025 Oregon Health Plan Newborn Notification Oregon Health Plan Pregnancy Notification Protected Health Information Disclosure Authorization Provider Disclosure Statement of Ownership and Control Form Provider Enrollment Request Acuerdo de pago por parte de clientes del OHP por servicios médicos Autorización para esterilización (edad 15-20) Autorización para esterilización​ (21 años y más) Autorización del miembro para permitir la divulgación de información protegida sobre la salud a otra persona o entidad Formulario de Quejas del Plan de Salud de Oregon Solicitud de apelación y audiencia por denegación de servicios médicos Прошение о проведении апелляции и слушания в связи с отказом в предоставлении медицинского обслуживания Соглашение об оплате медицинских услуг, полученных участником программы медицинского страхования OHP Бланк для подачи жалобы для участников программы льготного медицинского страхования штата Орегон (ОНР) نموذج PHI لترخيص OHSU نموذج PHI لترخيص OHSU OHSU Health Service Ủy quyền tiết lộ thông tin sức khỏe được bảo vệ Call 844-827-6572