Oregon payer contacts and where each application starts

Check what you learned

10 questions from this lesson. Answers are checked as you go; nothing is recorded.

1. 1 / 10

   What does the lesson say is the first step for a therapist applying to PacificSource in Oregon?

   ARegister for the CAQH Provider Data Portal and submit a profile notificationBLog in to the Availity Essentials portal and complete the Onboarding TrackerCDownload and complete the forms on the Contracting in Oregon page and email them to [email protected]DCall the provider relations line at 1-800-878-4445 to request an application
   Hint

   Look at the PacificSource section under Commercial payers.

2. 2 / 10

   According to the lesson, what does ORS 743B.454 require of a commercial insurer once a therapist submits a complete application?

   AA decision within 90 days and to accept and pay claims while deciding, possibly at a non-participating rateBA decision within 120 days and to provide a written explanation if deniedCA decision within 60 days and to pay at the in-network rate immediatelyDA decision within 30 days and to backdate the effective date to the application date
   Hint

   Find the paragraph titled "What the law requires of the payer once you apply."

3. 3 / 10

   What does the lesson say about the Regence BlueCross BlueShield of Oregon credentialing process regarding CAQH?

   ACAQH is not mentioned and Regence uses only a paper applicationBCAQH is optional and providers can choose between CAQH and a paper formCCAQH participation is required and the application goes through the CAQH Provider Data PortalDCAQH is required only for providers joining an already in-network group
   Hint

   Check the Regence BlueCross BlueShield of Oregon section under Commercial payers.

4. 4 / 10

   What does the lesson indicate is the first documented step for a therapist applying to Providence Health Plan in Oregon?

   AComplete an online request for participation through the Providence portalBSubmit a CAQH profile notification form to Providence's credentialing departmentCContact the provider representatives page at 1-800-878-4445 (TTY 711) weekdays 8 a.m. to 5 p.m. PacificDDownload and complete the New Provider Profile Form from the behavioral health contracting page
   Hint

   Look at the Providence Health Plan section under Commercial payers.

5. 5 / 10

   According to the lesson, what does Moda Health list as its first step for a therapist wanting to join its network?

   AComplete the CAQH Provider Data Portal application and notify ModaBSubmit a W-9 and provider information form through the Moda portalCCall the provider relations line to verify panel opennessDConfirm your specialty is listed for your area, which is Moda's way of saying applications are open
   Hint

   Find the Moda Health section under Commercial payers.

6. 6 / 10

   What does the lesson say about Kaiser Permanente Northwest's application process for Oregon therapists?

   AA paper application (Form 5333OR) is available and takes about six weeksBApplications are accepted through the CAQH Provider Data Portal with a 60-day response timeCAn online request for participation is the first step and Aetna responds within 60 daysDNothing documents an Oregon application; check with the payer
   Hint

   Look at the Kaiser Permanente Northwest section under Commercial payers.

7. 7 / 10

   According to the lesson, what is required for a therapist applying to UnitedHealthcare / Optum in Oregon regarding CAQH?

   ACAQH is not required and Optum uses its own proprietary application portalBCAQH participation is required in the majority of states and you enter your CAQH ID on the application where your state requires itCCAQH is required only for Medicare providers, not commercial plansDCAQH is optional and only needed for providers joining an already in-network group
   Hint

   Check the UnitedHealthcare / Optum section under Commercial payers.

8. 8 / 10

   What does the lesson say about the Cigna / Evernorth Behavioral Health application process?

   AFirst step: submit a paper application (Form 5333OR) with an IRS letter and allow 10 business days for trackingBFirst step: download forms from the Contracting in Oregon page and email them to [email protected]CFirst step: confirm your specialty is listed for your area on the Join our network pageDFirst step: log in or register for the provider portal; you need a CAQH identification number since Evernorth verifies information through CAQH
   Hint

   Look at the Cigna / Evernorth Behavioral Health section under Commercial payers.

9. 9 / 10

   According to the lesson, what is the first step OHA writes for Oregon Health Plan fee-for-service enrollment?

   ACreate a CMS Identity and Access Management (I&A) account for PECOSBComplete forms OHA 3972 and OHA 3975 plus the disclosure statement through the MMIS Provider PortalCFind out whether you are already enrolled, using OHA's online lookupDCall 800-336-6016, option 6 to request an enrollment packet
   Hint

   Check the Oregon Health Plan fee-for-service (OHA) section under Public payers.

10. 10 / 10

    What does the lesson say about the Medicare (PECOS) enrollment process for therapists?

    AFirst step is to download and complete forms on the Contracting in Oregon page and email themBFirst step is to log in or register for the provider portal and obtain a CAQH identification numberCFirst step is to confirm your specialty is listed for your area on the Join our network pageDThe page is a launch pad linking NPPES for your NPI and the PECOS enrollment system, and the PECOS login asks for a CMS Identity and Access Management (I&A) account, so create that first
    Hint

    Look at the Medicare (PECOS) section under Public payers.