Practice Tactics
Prior Authorization Removed for Select Services
As of October 1, 2025, the following services no longer require prior authorization (PA) for any provider.
| Code(s) | Description | Change | Effective |
| A9500–A9609 | Imaging contrast codes | No PA required | 10/1/2025 |
| 45385 | Colonoscopy with lesion removal | No PA required | 10/1/2025 |
| 81256 | HFE gene test | No PA required | 10/1/2025 |
| J0741 | Cabotegravir, rilpivirine | No PA required | 10/1/2025 |
New HRSN Timelines and Fee Schedule Updates
The Oregon Health Authority (OHA) has updated timelines for reviewing housing requests and announced upcoming changes to the HRSN fee schedule.
Timeline Changes for Determinations
- In effect since August 1, 2025: The maximum determination period for housing requests is 42 days from the date the request is received. This includes any extensions.
- Effective November 1, 2025: The maximum determination period will be further reduced to 28 days from the date the request is received, including extensions.
Fee Schedule Changes
- Effective November 1, 2026: Updates to the HRSN fee schedule will take effect. These changes will slightly increase the maximum allowable costs for rent and utilities benefits within our region.
- Current rule: 42-day maximum (since Aug. 1, 2025)
- Upcoming rule: 28-day maximum (effective Nov. 1, 2025)
- Fee schedule updates begin Nov. 1, 2026
UHA Launches New Risk Stratification Process
In June, Umpqua Health Alliance (UHA) Care Coordination launched a new risk stratification process using the Johns Hopkins Adjusted Clinical Groups (ACG) risk score. This evidence-based tool helps providers assess patient health risks and plan proactively for future care needs.
How the Process Works
- Care coordinators now reach out to all 44,000 members based on their assigned risk scores, which range from no risk to high risk.
- The process supports completion of the mandatory health risk assessment (HRA) within 90 days of a new member’s enrollment.
- After the HRA is submitted, a risk tier assessment validates the initial score. Care coordinators then confirm or adjust the score based on professional judgment.
Risk Tiers and Member Support
- No/low risk members are connected with a care navigator to address social determinants of health (SDoH).
- Moderate/high risk members are assigned a care coordinator, who develops an individualized care plan tailored to their needs.
Why It Matters
This structured workflow strengthens UHA’s whole-person, patient-centered approach. It ensures members receive the right level of support at the right time.
Providers may refer any UHA member to care coordination services by:
- Phone: Call 541-229-4842 and ask for the Care Coordination Department.
- Email: Submit the Case Management Form to casemanagement@umpquahealth.com.
Flex Transportation Benefit Revisions Now in Effect
As of October 1, 2025, Umpqua Health Alliance (UHA) implemented revisions to the Flex Transportation benefit under the Bay Cities Brokerage (BCB) contract. These changes support appropriate use of plan resources while maintaining sustainable access to transportation for members.
Summary of Changes
- Eligible members will move from per-trip Flex rides to a monthly bus pass program.
- Once issued, the pass allows unlimited rides on the local bus system for the month.
- Eligibility is determined when a member has three or more covered trips in a calendar month.
- BCB will notify qualifying members. Passes may be mailed or picked up through Umpqua Transit.
- High-cost nonmedical rides are no longer covered, including Chadwick House transportation (already provided by the facility).
- Additional exclusions: gyms and fitness clubs, Lamaze classes, equine therapy, in-person weight loss programs, and mileage reimbursement for Flex rides unless approved by UHA Utilization Management.
- Nonemergent medical transportation (NEMT) through BCB remains unchanged and continues to be available for qualifying health-related appointments.
Covered Trips (with limits or documentation)
- One pharmacy trip per month
- Up to two grocery trips per month, when scheduled in advance and combined with another appointment
- Scheduled DHS or WIC visits (documentation required)
- Scheduled self-help or recovery group meetings (documentation required)
- UHA Community Advisory Council (CAC) or other UHA-sponsored community health meetings (documentation required)
Provider Role
- Reassure members that medical transportation is not changing.
- Do not direct members to Chadwick House rides through Flex, as this service is no longer covered.
- Redirect member transportation questions to Customer Care at 541-229-4842 (TTY: 541-440-6304).
- For provider-specific inquiries, call 541-229-4842 and ask for Provider Relations.
THW Connections Corner
Meet Amanda Bartkus! All Amanda really wanted from her career was to help people and make a difference. She found that opportunity as a family support specialist at Adapt, where she has worked for the last three years.
“I am there for people who don’t have anyone else, those who often suffer in silence. As parents, we’re often overlooked, especially when our kids are going through the big stuff. Knowing I get to make parents feel not alone, seen, heard, and valued is the most amazing part for me.”
One of the most common barriers her clients experience is falling into income gaps that make them ineligible for services. “People often make too much for help but not enough to do whatever is needed on their own,” she said. Many also don’t know what resources are available. “Everyone deserves access to all types of healthcare, regardless of whether they have money or not.” she shared. “One should not have to go into debt to get the help they need. Many people will avoid needed healthcare, mental and physical due to funds.”
Amanda credits her ability to truly listen as a key attribute that makes her good at her job. “I’m very nonjudgmental and truly there for my families no matter what they are experiencing.”
But the job isn’t always easy. She works hard to keep her work life separate from her home life. “Some of the families I help don’t have anyone else and I become their person for a short time. I take those feelings home with me sometimes.”
Her advice for those entering the field:
“This path transforms you. You’ll uncover parts of yourself you didn’t know existed, along with strengths you possess. But don’t bring it home!“
THW Panel Featured at Provider Summit
Date and Time:
Thursday, Oct. 16, 2025
5:30–8 p.m.
Location:
Evergreen Family Medicine — Harvard Location
Event Highlight: Traditional Health Worker Panel
The Douglas County Provider Summit will feature a Q&A panel with Traditional Health Workers (THWs) from across the community.
Andrea Brown, THW liaison with Umpqua Health Alliance, will begin with an overview of THWs and the goals of her liaison role. She will highlight key projects the THW provider community has undertaken, as well as recent efforts to strengthen organization and collaboration.
Following her remarks, a panel of THWs will:
- Introduce themselves and their roles within local agencies
- Share perspectives from clinical and community-based settings
- Represent all five THW worker types, spanning direct service and administrative roles
- Take questions from providers in attendance
This panel offers providers an opportunity to better understand how THWs support patients and collaborate with the healthcare system.
Registration
To attend the Douglas County Provider Summit, register here.
CME for Thee
Mental Health First Aid Training in Roseburg
Free Training | Oct. 22–23, 2025 | Roseburg
Dates and Time:
Oct. 22–23, 2025
12–4 p.m. each day
Location:
Aviva Health Kenneth Ford Conference Center, 150 NE Kenneth Ford Drive, Roseburg, OR
Learn how to recognize and respond to adults experiencing mental health or substance use challenges. This free training provides practical skills through the evidence-based Mental Health First Aid (MHFA) curriculum.
What You’ll Learn:
- Purpose of MHFA and the role of a Mental Health First Aider
- Five steps of the MHFA Action Plan (ALGEE)
- Recognizing signs and symptoms of mental health challenges
- Applying ALGEE in noncrisis and crisis situations
- Self-care strategies for First Aiders
Clinical Corner
Formulary and Criteria Updates for Providers
The following changes to the Umpqua Health Alliance formulary and prior authorization (PA) criteria are effective immediately.
Formulary Updates
| Drug / Product | Formulary Status | Notes / Restrictions |
| Cabenuva | Added, no PA | Long-acting injectable for HIV-1 treatment |
| Esomeprazole DR 20 mg & 40 mg capsules | Added | Quantity limit: 1 per day. Used for excess stomach acid |
| Estradiol 0.1% gel packet | Added | Treats symptoms of menopause (e.g., hot flashes, night sweats) |
| FreeStyle Libre Plus 2 & Plus 3 Sensors | Added, PA required | Updated sensors. Older Libre 2 & 3 phased out by manufacturer |
| Glucose gel and tablets | Added | Treats low blood sugar |
| Magnesium glycinate 100 mg capsule | Added | Dietary supplement |
| Ranolazine ER | Added, no PA | Used for chronic angina |
| Selenium sulfide 1% shampoo | Added | Treats dandruff and seborrheic dermatitis |
| Valacyclovir | Updated | Time frame removed from quantity limits. Allows longer treatment duration |
Criteria Updates
- SGLT2 Inhibitors
- Removed requirement for cardiologist consultation
- Updated Farxiga to generic name: dapagliflozin
- Revised preferred vs. nonpreferred product list
- Insulins
- PA criteria updated to clearly list formulary and nonformulary insulins
PEN-FAST Score Validated in Pediatric Allergy Assessment
This content is adapted from NEJM Journal Watch, Aug. 13, 2025. It summarizes findings from a study published in the European Journal of Pediatrics.
New evidence supports the use of the PEN-FAST scoring system in children and adolescents to assess risk for true penicillin allergy.
Study Design and Results
- Design: Retrospective study from Turkey
- Population: 700 children and adolescents (ages 6–18) with suspected penicillin allergy
- Methods: Standardized assessment with selective skin testing and observed oral challenge
- Findings:
- Penicillin allergy confirmed in 64 patients (9%)
- All confirmed cases had PEN-FAST scores of 3 or higher (100% sensitivity)
- No patients with scores <3 had penicillin allergy
- Specificity was 45%
A PEN-FAST score of 3 or higher had perfect sensitivity. A score below 3 had perfect negative predictive value.
Clinical Significance
This suggests observed oral amoxicillin challenges may be safe for low-risk children and adolescents, similar to findings already validated in adults.
PEN-FAST Scoring
| Criteria | Points |
| Allergy event within past 5 years | 2 |
| Anaphylaxis, angioedema, or severe cutaneous reaction | 2 |
| Treatment required for allergy episode | 1 |
Interpretation:
- 0–2 points: Low risk (<5% true allergy) → may proceed with oral challenge
- 3+ points: Higher risk → further testing indicated
Provider Perspective
“As a practicing allergist, I use this tool at least weekly. It gives clinicians confidence to move forward with direct oral amoxicillin challenges for low-risk patients.”
— David J. Amrol, MD
Citation
- Source: Güvenir FA et al. PEN-FAST in pediatrics: A reliable tool for penicillin allergy assessment? Eur J Pediatr. 2025 Jul 2; 184:463. DOI link
- Commentary: David J. Amrol, MD, originally published in NEJM Journal Watch, Aug. 13, 2025
Community Announcements
Douglas County Provider Summit
Date and Time:
Thursday, Oct. 16, 2025
5:30–8 p.m.
Location:
Evergreen Family Medicine — Harvard Location
Featured Speakers:
- Cordell B. Smith, DPM | Upstream Healthcare: What’s My Role in the Chronic Disease Epidemic?
- Sandesh Pandit, MD | Updates in Regenerative Medicine / Orthobiologics
- Garrett Stroup, PT, DPT, VRC | The Evaluation and Treatment of Concussions
- Andrea Brown, CHW, PSS | THW: Aiding Providers in Hiring, Training, Certification, and Use of Services (Concludes with panel discussion)
Registration:
Child Safety Series in Green
Hosted by:
Douglas County Perinatal Taskforce and community partners
Date and Time:
Thursday, Oct. 16, 2025
5:30–7:30 p.m.
Location:
Green Elementary School— 4498 Carnes Rd, Roseburg, OR 97471
This free, four-part series features local speakers sharing practical tips to keep families safe and thriving. Families can enjoy a free dinner together. On-site childcare will be provided so parents and caregivers can fully participate.
Registration:
Network News
Network Changes
Termed Providers and Facilities
| Alvarado, Troy, CRM — Adapt Integrated Health Care | September 5, 2025 |
| Collard, Shannon Alyse, QMHA — Adapt Integrated Health Care | September 2, 2025 |
| Cote, Maggie, DMD — Advantage Dental | September 4, 2025 |
| Delzell, Janae Lee, CRM — Adapt Integrated Health Care | September 16, 2025 |
| Follett, Steven, MD — Anesthesia PC | September 11, 2025 |
| Geary, Kirk, PSS-AMH — Adapt Integrated Health Care | September 4, 2025 |
| Gordon’s Pharmacy | September 1, 2025 |
| Hernandez, Heather, PA-C — Evergreen Family Medicine | August 16, 2025 |
| Horrell, Daniel T., DO — PeaceHealth | July 27, 2025 |
| Koti, Susmitha, DDS — Advantage Dental | August 31, 2025 |
| Palmer, Rebecca, MD — PeaceHealth | August 30, 2025 |
| Popuch, Jane, CADC I — Adapt Integrated Health Care | September 11, 2025 |
| Ransom, Charlette, MD — Adapt Integrated Health Care | August 31, 2025 |
| Riverland, April, PA-C — Umpqua | September 11, 2025 |
Added Providers and Facilities
| Adam J. Gordon, Brian, MD — Anesthesia PC | May 27, 2025 |
| Ali Cheaito, Mohamad, MD — Mercy Medical Center | August 1, 2024 |
| Barman, Raj, DO — Peace Harbor Florence | August 29, 2025 |
| Black, Jeremy, PA — Mercy Medical Center | December 1, 2024 |
| Borota, David, DDS — Rogue River Endodontics | August 5, 2025 |
| Burnett, Arielle, DMD — Aviva Health Roseburg | September 8, 2025 |
| Burkhead, Byron, MD — Anesthesia PC | February 3, 2025 |
| Critchfield, Mark, MD — Anesthesia PC | Jan. 20, 2025 |
| Dorrough, Michael, MD — Anesthesia PC | January 13, 2025 |
| Force, Jonathan, MD — Anesthesia PC | August 18, 2025 |
| Fox, Robin, PA-C — PeaceHealth Cottage Grove | August 24, 2025 |
| Gadbois, Jaclyn, MD — Mercy Medical Center | August 1, 2025 |
| Groesbeck, Philip, MD — Anesthesia PC | March 24, 2025 |
| Groshong, Andrew, MD — Kids Docs PC | July 29, 2025 |
| Groshong, Natalie, MD — Evergreen Medical Harvard | August 13, 2025 |
| Hagebak, Robert, MD — Anesthesia PC | July 17, 2024 |
| Hall II, Robert, MD — Anesthesia PC | February 24, 2025 |
| Harrison, Matthew, MD — Anesthesia PC | March 24, 2025 |
| Haskell, Tyler, MD — Anesthesia PC | March 10, 2024 |
| Heist, Robert, DDS — Aviva Health Roseburg | September 8, 2025 |
| Huraibi, Hussein, MD — Anesthesia PC | August 12, 2024 |
| Hyde, Spencer, DO — Anesthesia PC | February 10, 2025 |
| Joseph, Surya, DMD — The Smile Station | January 15, 2025 |
| Joshi, Priyanka, DDS — Advantage Dental | November 12, 2024 |
| Klingler, Kendell, MD — Anesthesia PC | January. 6, 2025 |
| Knous, Katelynn, EPDH — Advantage Dental Outreach | September 13, 2024 |
| Kreidel, Kerry, MD — Anesthesia PC | November 18, 2024 |
| Kuehne, Catherine, MD — Mercy Medical Center | September 1, 2024 |
| Lawrence, Jenna, PA-C — Mercy Medical Center | August 1, 2024 |
| Larsen, Nicholas, DO — Anesthesia PC | December 17, 2024 |
| Lippincott, Jordan, MD — Mercy Medical Center | August 1, 2024 |
| Mackintosh, Natalie, MD — Anesthesia PC | September 1, 2025 |
| Malekzadeh, Arash, MD — Anesthesia PC | November 4, 2024 |
| Meron, Shannon, MD — Anesthesia PC | July 7, 2025 |
| Morales Villareal, Luis, DMD — Advantage Dental Reedsport | September 3, 2024 |
| Murdock, Brent, DO — Anesthesia PC | February 24, 2025 |
| Murri, Miles, DO — Anesthesia PC | February 10, 2025 |
| O’Hara, Bruce, DDS — Aviva Health Roseburg | January 15, 2025 |
| Pak, Edward, MD — Mercy Medical Center | March 1, 2025 |
| Palmer, Nicole, MD — Mercy Medical Center | September 1, 2024 |
| Phan, Elizabeth, DMD — Advantage Dental | July 21, 2025 |
| Read, Daniel, PA-C — Mercy Medical Center | December 1, 2024 |
| Rees, Jeffrey, MD — Anesthesia PC | February 3, 2025 |
| Romanelli-Gobbi, Massimiliano, MD — Anesthesia PC | April 7, 2025 |
| Skanchy, Jeffrey, MD — Anesthesia PC | January 6, 2025 |
| Schiller, Nicholas, MD — Anesthesia PC | March 31, 2025 |
| Short, Lucas, DO — Mercy Medical Center | July 1, 2025 |
| Stark, Julie, PA-C — Mercy Medical Center | September 1, 2024 |
| Tamborski, Maria, MD — Mercy Medical Center | August 1, 2025 |
| Thomas, Mark, MD — Anesthesia PC | January 6, 2025 |
| Townsend, Carmel, DDS — Advantage Dental | September 14, 2023 |
| Vittetoe, Emmalee, PA — Mercy Medical Center | August 1, 2025 |
| Wang, Lena, MD — Anesthesia PC | August 5, 2024 |
| Wood, Jonathan, MD — Anesthesia PC | March 17, 2025 |
Meet UHA’s Provider Relations Team
Who We Are
The Provider Relations team at Umpqua Health is dedicated to building strong, collaborative relationships with our provider network. We offer guidance, support, and resources to help providers deliver high-quality care.
What We Do
- Assist with onboarding and training
- Serve as a point of contact for questions and support
- Communicate updates and policy changes
- Collaborate across teams to resolve issues
- Advocate for provider needs and experience
Meet the Team
Kammy Fegles, MHA — Manager, Provider Relations
Leads the team with a focus on consistency, collaboration, and service excellence to ensure a positive provider experience.
Chanda Wells — Provider Relations Specialist
Delivers responsive, knowledgeable support for provider claim inquiries, ensuring timely and accurate resolutions.
Joy Kimbrough — Provider Relations Specialist
Brings a solution-focused, provider-first approach to every interaction, emphasizing thoughtful and effective service.
Jenn Johnston — Provider Relations Representative (HRSN)
Supports providers engaged in HRSN, providing training and guidance in a complex and evolving area of care.
McKenna Burns – Provider Relations Representative
Provides attentive support to both new and established providers, building strong relationships through consistent communication.
Nick Rogers- Provider Relations Coordinator
Responsible for managing provider data entry and maintenance, ensuring timely updates and precision in records, while upholding the integrity and quality of the Provider Directory.
Contact Us:
- General Provider Services: UHNProviderServices@umpquahealth.com
- Claims Inquiries: UHAclaims@umpquahealth.com
- Phone: 541-229-4842
On the Lookout
New Strain Drives Record Norovirus Season
The 2024–2025 season has been a record-breaking year for norovirus outbreaks in the United States, driven by a new strain called GII.17.
About the GII.17 Strain
- GII.17 has evolved different surface proteins that the immune system does not recognize, increasing susceptibility to infection.
- The strain binds more effectively to intestinal cells, making it easier to spread.
What Providers Should Know
- Transmission: Norovirus spreads through contaminated food and water, person-to-person contact, and contaminated surfaces.
- Common settings: Schools, child care centers, health care facilities, and cruise ships.
- Contagion: Only a few viral particles can cause illness. The virus can survive on surfaces for long periods.
- Symptoms: Vomiting, stomach cramps, and diarrhea. Most cases are mild and self-limiting within a few days.
- Treatment: Supportive care—hydration is key.
Prevention Recommendations
- Wash hands with soap and water (hand sanitizers are not effective).
- Wash fruits and vegetables thoroughly.
- Cook shellfish (oysters, clams, mussels) fully, as they can concentrate the virus.
- Wash exposed clothing, bedding, and towels in hot water with detergent.
- Disinfect contaminated surfaces with bleach-based or EPA-registered disinfectants effective against norovirus.
At a Glance
- No vaccine is currently available.
- Most water filters do not remove norovirus.
- Frequent hand washing remains the most effective preventive measure.
Source: Adapted from CDC.gov.
Number of suspected or confirmed norovirus outbreaks reported by NoroSTAT-participating states per week, 2012–2025. Source: CDC.
Dental Digest
All About Broken Tooth Treatment
A broken tooth can happen for many reasons, including sports injuries, biting hard foods, untreated cavities, prior dental work, or tooth grinding. Sometimes a small chip may cause little or no pain, while a larger break can be very painful.
Treatment depends on the severity of the fracture, with options such as bonding, root canal therapy, or implants. These treatments aim to ease pain, restore function, and protect long-term oral health.