Practice Tactics
Benefit Plan Updates: Prior Authorization Changes
We routinely review and update our benefit plan to ensure coding and prior authorization (PA) requirements reflect current clinical standards. Below are the latest changes. Please review and update your records as needed.
| Code / Description | Change |
| J0609 – Ferric citrate, oral, 3 mg ferric iron | No PA required for any provider |
| J9045 – Injection, Carboplatin 50 mg | No PA required for any provider |
| 81240 – Gene analysis (prothrombin, coagulation factor II) A variant | No PA required for any provider. Effective July 1, 2025 |
| 81241 – Gene analysis (coagulation factor V) Leiden variant | No PA required for any provider. Effective July 1, 2025 |
| S5517 – Home infusion therapy, all supplies necessary for restoration of catheter patency or declotting | PA required |
Interpreter Services to Help You Deliver Culturally Responsive Care
Clear communication is essential to high-quality care. When language barriers exist, they can impact understanding, safety, and outcomes for patients. To support you in caring for members with limited English (LEP) proficiency, Umpqua Health offers professional language services at no cost.
UHA partners with Oregon Qualified and Certified Health Care Interpreters (HCIs) who are trained to work in clinical settings. These interpreters help reduce communication gaps, ensure accuracy, and support culturally responsive care so you can focus on delivering effective treatment.
Interpreter services available to you:
- Linguava – Spoken Language & Sign Language
503-265-8515 | sales@linguava.com - Oregon Certified Interpreter Network (OCIN) – Spoken & Lesser Diffusion Language
503-213-3191 | carlos@oregoncertified.com - All Hands – American Sign Language
541-729-7111 | ahis2.scheduling@gmail.com - Ana Garcia – Spanish (in-person)
541-537-2553 | anavazquez1980@gmail.com - Gaby Rosales – Spanish (in-person)
541-530-3752 | gabyrosales1497@gmail.com
To request interpreter services or coordinate care for a member with communication needs, contact UHA Member Services at 541-229-4842 and ask for a care coordinator.
THW Connections Corner
Local CHW Training Program in Development – Participant Support Needed
Douglas County is partnering with Coos and Curry counties to develop a Community Health Worker (CHW) foundational training program designed specifically for our rural communities. With permission from Multnomah County, we are adapting their approved CHW curriculum to reflect local needs, resources, and cultural context.
We are seeking certified CHWs from each of the three counties to contribute their experience to this effort. These CHWs will be active participants in shaping a training model that reflects the realities of rural health work.
Ideal participants:
Participants with facilitation experience may also be considered as future trainers once the program is approved.
Workgroups meet weekly by county, with full regional meetings every 3 to 4 weeks. Meetings are currently held virtually.
To refer a CHW or learn more, contact Andrea Brown, THW Liaison, at abrown@umpquahealth.com.
Clarifying the Use of Z Codes as a Primary Diagnosis
As Traditional Health Workers (THWs) continue to support member care through preventive and community-based services, billing guidance is evolving. One area that has caused confusion is the use of Z codes as a primary diagnosis on claims.
Z codes are ICD-10 codes used to identify Social Determinants of Health (SDoH), including housing insecurity, lack of transportation, and food access. While Z codes are within the THW scope of work, Oregon does not currently allow them to be billed as a primary diagnosis.
The Centers for Medicare & Medicaid Services (CMS) allows Z codes to be used as primary diagnoses, and states such as South Dakota and California have started using them for certain THW services. However, this is not yet standard practice in Oregon.
The Oregon Health Evidence Review Commission is reviewing Z codes for use as a primary diagnosis under the ILOS billing model. We are hopeful for updated guidance soon.
To avoid claim denials, Z codes should be submitted only as secondary diagnoses. If you have concerns about recent claim denials, please contact Andrea Brown at abrown@umpquahealth.com.
CME for Thee
Oregon Medical License Renewals Open October 1
Physicians and physician associates licensed in Oregon can begin renewing their medical licenses starting October 1, 2025. The deadline to complete the process is December 31, 2025.
To help make renewal smooth and efficient, review the following checklist:
Continuing Education Reminders
The Oregon Medical Board requires continuing education to support lifelong learning and high-quality patient care.
- General CE: Maintain board certification or provide documentation of continuing medical education hours.
- Pain Management: Complete the Oregon Pain Management Commission’s free 1-hour course, Transforming Pain Management: A Journey to Better Care, every two years.
- Cultural Competency: Complete 1 hour of cultural competency training every year. Topics should support effective care for patients from diverse communities.
Clinical Corner
Support for Patients Managing Chronic Medications
Umpqua Health Alliance (UHA) offers a Medication Management (MM) program to support members who need help managing chronic medications.
Medication Management incorporates a set of pharmacist-led services designed to optimize drug therapy and improve health outcomes. The UHA Pharmacy team includes licensed pharmacists and pharmacy technicians with expertise in medication management. The team works closely with providers to ensure each member’s treatment plan supports their therapeutic goals. The UHA Pharmacy team helps members get the most benefit from their medications by managing therapy and identifying, preventing, and resolving medication-related problems.
Medication Management Services
Our Medication Management services include:
- Medication synchronization: Coordinating refills to minimize pharmacy trips.
- Medication reconciliation: Reviewing and verifying all current medications to ensure accuracy, safety, and understanding.
- Dose orchestration: Aligning doses and timing to maximize effectiveness and simplify schedules.
- Medication education: Explaining medication names, purposes, side effects, and precautions to improve understanding and safety.
- Adherence assistance: Identifying barriers to medication use and developing strategies to improve adherence.
When Medication Management is Most Valuable
- Medication Management is especially valuable for members who have:
- Multiple chronic conditions: Such as diabetes, hypertension, and asthma.
- Complex medication regimens: Many medications or multiple drug types requiring expert oversight.
- High medication costs: Members with significant annual prescription expenses.
- Multiple prescribers: To ensure safe and coordinated medication use across different providers.
Accessing Medication Management Services
Medication Management services are available by referral from either members or providers:
- Member self-referral: Members may contact the UHA Pharmacy Team directly to request enrollment and a pharmacist-led medication review. Forms can be filled out independently or initiated with assistance by phone.
- Provider referral: Providers, case managers, or care team members may refer members at risk for, or experiencing, medication-related problems, adherence issues, or other medication challenges.
How to Refer
Submit completed forms via:
Fax: (541) 677-5881
Email: UHPharmacyServices@UmpquaHealth.com
Community Announcements
No announcements this month.
Network News
Umpqua Health Alliance Network Changes
Termed
| Brenda Butterfield, QMHA-I – Adapt Integrated Health Care | August 6, 2025 |
| Rachel Castellano, CRM II – Adapt Integrated Health Care | August 13, 2025 |
| Connie Grice, QMHP-R – Adapt Integrated Health Care | July 31, 2025 |
| Kaius Alexander Hall, QMHP – Adapt Integrated Health Care | September 5, 2025 |
| Shar’Ron De Norris, LPC – PeaceHealth | August 18, 2025 |
| Dawn Rarick, QMHA-I – Adapt Integrated Health Care | July 17, 2025 |
| Karla Whitlock, LPC – Adapt Integrated Health Care | July 31, 2025 |
Additions
| Dawn Aanrud, THW, Birth Doula – Eugene Birth & Family | August 4, 2025 |
| Jessica Compton, MSW, CSWA – Aviva Health | July 7, 2025 |
| Heather Coates, CADC II – Adapt Integrated Health Care | July 9, 2025 |
| Alyssa Emo, DO – Evergreen Family Medicine – Harvard | September 1, 2025 |
| Mathew Ercolani, MD – Centennial Medical Group Inc. | August 4, 2025 |
| Eric Geisler, MD – Aviva Health | July 7, 2025 |
| Natalie Groshong, MD – Evergreen Family Medicine – Harvard | August 27, 2025 |
| Frederick Jacobs, AuD – | July 21, 2025 |
| Robin Jewett, PA-C – CRM Physicians LLC | June 2, 2025 |
| Eleanor McAvoy, DNP – Adapt Integrated Health Care | August 25, 2025 |
| Lindsay Mackey-Laudermilch, MS, FNP – Boulder Care Provider Group PA | August 4, 2025 |
| Larissa Miller, CADC-III – Affect Therapeutics, Inc. | August 4, 2025 |
| Andrew Neeb, MD – Centennial Medical Group Inc. | August 4, 2025 |
| Jessica Pericles, MSN, PMHNP – Affect Therapeutics, Inc. | August 4, 2025 |
| Tirsa Sparr, LPC – Joyful Living Behavioral Health | August 4, 2025 |
| Becky Thompson, LPC – Roseburg Therapy LLC | August 4, 2025 |
| Robert Walker, MD – Roseburg Radiologists PC | August 4, 2025 |
| Jason Williamson, CADC-I, LPC – Affect Therapeutics, Inc. | August 4, 2025 |
| Summer Wintersteen, BCBA – Positive Behavior Supports Corporation | August 4, 2025 |
| Tyler Wood, PA-C – Valley Ridge Family Medicine | August 4, 2025 |
| Heather Youngs, LPC – Affect Therapeutics, Inc. | August 4, 2025 |
| Daniel Young, PA-C – PeaceHealth | July 16, 2025 |
Umpqua Health Alliance (UHA) invites clinical and community partners to participate in our Biannual Social Determinants of Health (SDoH) Clinical and Community Partner Collaborative.
This interactive virtual event brings together teams involved in social needs screening and referral processes. It’s an opportunity to share insights, strengthen partnerships and develop strategies to improve SDoH outcomes across the region.
We encourage organizations to attend as teams. Group participation supports workflow alignment, shared learning, and more effective implementation of SDoH initiatives.
Thursday, Nov. 6 | 12 PM – 1:30 PM (Virtual Meeting)
For more information contact the UHA Quality Improvement team at UHQualityImprovement@umpquahealth.com.
On the Lookout
Test Kids for Lead: It Makes a Difference!
Douglas Public Health Network (DPHN) has a new tool to support elevated blood lead level investigations in children. With only 21% of Oregon Health Plan (OHP)-enrolled children ages 1 to 3 tested for lead in 2023, many cases of lead exposure may be going undetected in Douglas County. Lead poisoning can cause lasting developmental and behavioral challenges. Routine screening is the best way to identify exposure early and prevent harm.
Why Testing Matters
Even low levels of lead in the bloodstream can negatively affect development, behavior, and learning. Because symptoms often go unnoticed, screening is essential to detect exposure and connect families to support.
Oregon Screening Requirements
Oregon Administrative Rule (OAR 410-151-0040) requires lead screening for all OHP-enrolled children at 12 and 24 months of age.
- A venous blood draw is preferred.
- Capillary screening is acceptable but must be confirmed with a venous draw if blood lead levels are 3.5 μg/dL or higher.
Local Investigation Process
The Oregon Health Authority (OHA) conducts follow-up for other adults with blood lead levels of 10 μg/dL or higher.
Local public health authorities are required to follow up on all blood lead levels of 3.5 μg/dL or higher in children under 18 and in pregnant or lactating individuals.
Emily Porter, Communicable Disease Epidemiologist at DPHN, is certified by OHA as a Lead Risk Assessor. She conducts surface-by-surface investigations to identify lead-based paint or other hazards. Emily inspects properties, collects samples, explains test results, and helps families explore strategies to reduce their child’s exposure to lead.
New Tool for Lead Detection
In June, Douglas County purchased a handheld lead analyzer to support pediatric investigations. The tool uses X-ray fluorescence to detect lead in paint, soil, toys, tools, furniture, and other materials. It can scan through multiple paint layers, provides results in 2 to 6 seconds, and does not damage the surface being tested.
Case Example: A Success Story
Last month, Emily used the new analyzer while investigating the home of two children with elevated blood lead levels. After a thorough inspection, she identified painted stoneware dinner plates as the likely source of exposure.
Thanks to the pediatrician who ordered routine screening, public health was able to respond, and the family was able to remove the hazard quickly. Thank you to our clinical partners for helping protect children’s health through early detection and referral.
Dental Digest
How to Remove Coffee and Tea Stains from Your Teeth
For many of us, a good day begins with a warm mug in hand. Whether that’s a bold cup of coffee, a creamy cappuccino or a calming herbal tea. These comforting beverages are more than just a pick-me-up. They’re part of our daily routines, our social rituals and even our moments of peace.
But there’s a downside to our love of coffee and tea that most of us have noticed at some point: they can stain our teeth. Over time, those daily drinks can turn a bright smile dull or leave behind yellow or brown discoloration, especially on the front teeth.
The good news? You don’t have to give up your morning brew to maintain a radiant smile. By understanding why stains happen (and what you can do to prevent or help them) you can continue enjoying your favorite beverages without worry.
Social Determinants of Health Clinical & Community Partner Collaborative