Cartel en español sobre la línea directa confidencial de cumplimiento de Umpqua Health Alliance para reportar inquietudes sobre fraude, desperdicio, abuso y privacidad, disponible al (844) 348-4702 o en línea.

Poster informing employees about Umpqua Health Alliance’s confidential compliance hotline for reporting concerns related to compliance, fraud, waste, abuse, and privacy, available by phone at (844) 348-4702 or online.

Umpqua Health Alliance corporate policy (CE22) governing payment and authorization of hospital admissions, including provider notification requirements, concurrent review processes, and post-discharge planning coordination.

Umpqua Health Alliance corporate policy (CE21, Version 13) requiring written notification to members when an adverse benefit determination is made, including denials, reductions, or terminations of coverage, in compliance with OAR 410-141-3835 through 410-141-3915 and 42 CFR § 438.400 through 438.424.

Umpqua Health Alliance corporate policy (CE19) defining covered substance use disorder services and requirements, including criteria for treatment authorization, levels of care, and coordination with behavioral health providers.

Umpqua Health Alliance corporate policy (CE12) outlining prior authorization requirements, processes, and timelines for medical, behavioral health, and pharmacy services, including provider submission requirements and member notification procedures.

Umpqua Health Alliance corporate policy (CE11) defining covered services under the Oregon Health Plan, including the scope of benefits, exclusions, and procedures for determining coverage for physical health, behavioral health, and dental services.

Umpqua Health Alliance corporate policy (CE05) establishing procedures for utilization review, including criteria for reviewing service requests, decision timelines, and member and provider notification requirements.

Umpqua Health Alliance corporate policy (CE03, Version 8) establishing a framework for Wraparound care services for youth members and their families, tailored to individual needs in compliance with OAR 309-019-0162 and OAR 309-019-0163 and aligned with the CCO Contract with OHA.

Umpqua Health Alliance corporate policy (CE01, Version 19) establishing internal grievance and appeal procedures under which members, authorized representatives, or providers may file complaints or appeal adverse benefit determinations, in compliance with OAR 410-141-3835 through 410-141-3915 and 42 CFR § 438.400 through 438.424.

Resource list compiled from the National Institute of Corrections’ 2020 Becoming Trauma-Informed Webinar Series, including videos, readings, and tools to support trauma-informed practices in behavioral health and community care settings.

Reference chart of Umpqua Health Alliance’s 2025 focus measures for Oregon Health Plan quality improvement, including adolescent and childhood immunizations, SUD treatment engagement, language access, and diabetes HbA1c poor control.