Provider Termination Form
Form for contracted providers to initiate voluntary termination from the Umpqua Health Alliance provider network, with fields for provider information and required notice details.
Provider Reconsideration and Claim Dispute Form
Provider request form for claim reconsideration or dispute, submitted one form per claim, with fields for provider and claim details and the basis for reconsideration, subject to applicable filing limits.
Claims Support NDC Validation Process
Flowchart documenting Umpqua Health Alliance’s NDC (National Drug Code) validation process for claims adjudication, showing how CIM validates NDC codes against the FDA Medicaid Drug Reimbursement File and how claims with missing or mismatched NDC codes are denied or processed.
Submitting Provider Enrollment Requests
Instructions for submitting provider enrollment requests to Ayin (OHA’s credentialing system), including required documents for individual providers and facilities and links to the relevant OHA enrollment forms.
Appendix A Telehealth Code Descriptions
Reference table listing CPT and HCPCS codes approved for telehealth billing with Umpqua Health Alliance, including required GT modifiers, covering psychiatric evaluations, psychotherapy, E/M services, and other eligible services delivered via telehealth.
How to Upload Additional Documentation
Step-by-step instructions for providers on uploading supporting documentation and submitting claims appeals in Umpqua Health Alliance’s CIM system, covering Level I appeal submissions and document attachment procedures.
Member Benefits Summary Flyer – Spanish
Conozca los servicios para miembros disponibles sin costo.
Member Benefits Summary Flyer
Learn about the member services available at no cost.
Food Hero Classes – Spanish
Food Hero Classes – English
Flyer promoting free Food Hero cooking and nutrition classes through OSU Extension Service, offering Umpqua Health members hands-on instruction in preparing healthy, affordable meals.
Food Hero Diabetes Friendly Recipes – Spanish
Guía en español de Héroe de Alimentos con recetas amigables para la diabetes, consejos de jardinería, y nutrición de OSU Extension, para ayudar a los miembros a controlar el azúcar en sangre.
Food Hero Diabetes Friendly Recipes – English
Food Hero resource guide from OSU Extension featuring diabetes-friendly recipes, gardening tips, and nutrition information designed to help members manage blood sugar through healthy, budget-conscious eating.