In your handbook, you will find:

1. Introduction: Offers an overview of Umpqua Health, explaining what a Coordinated Care Organization is and the benefits of the Oregon Health Plan.
2. Key Contacts: A list of important contacts for providers to connect with for various needs and inquiries.
3. Glossary of Terms: A reference section defining key terminology used throughout the handbook.
4. Provider Services: Covers essential provider-related topics, including credentialing, locum tenens agreements, primary care provider responsibilities, provider availability, billing procedures, cultural considerations, and provider participation guidelines.
5. Medical Management: Outlines the procedures for service coverage, prior authorizations, pharmacy management, urgent care, behavioral health services, case management, and quality assurance. It also includes important policies regarding emergency care and hospital services.
6. Filing Claims: Provides detailed instructions on how to submit claims, including guidelines for paper and electronic claims, eligibility verification, claim denials, and the appeals process.
7. Benefits & Services: Describes the benefits available under the Oregon Health Plan, including preventive services, maternity care, vision and hearing benefits, dental services, emergency medical transport, and more.
8. Member Rights and Responsibilities: Outlines the rights and responsibilities of members, including how providers should handle grievances, appeals, and patient advocacy. It also addresses access to care standards for special needs members.
9. Documentation: Defines the necessary documentation requirements, including medical records, advance directives, and compliance with privacy laws such as HIPAA.
10. Compliance: Provides information on Umpqua Health’s compliance policies, including the code of conduct, fraud prevention, and reporting procedures for concerns related to fraud, waste, and abuse.

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