How can I access the Prioritized List within CIM?
1. From the main menu, select “Provider Services” 2. Select “Health Systems Division Line Search” 3. Search by diagnosis code and/or procedure code
Who can I talk to about a claim?
You may select the “claims” option by calling Member Services at (541) 229-4842.
If my patient has other primary insurance, do we need to get prior authorization?
If OHP/UHA is not the primary insurer, then a prior authorization is not required. If the prior insurance does not cover the requested service/item, then provide the non-coverage information [...]
What is the difference between these lines?
The Prioritized List of Health Services has 660 lines ranked based on clinical effectiveness and cost-effectiveness. Lines 1-469 are funded, with these condition-treatment pairs placing a higher [...]
What is code pairing?
This is when a diagnosis code and a procedure code both appear on the same line in the prioritized list.
I received a partial denial on a prior authorization. What was approved?
Review the notification you received with the determination. This should indicate what was denied, but also what was approved. If you still have questions, please contact Member Services at [...]
This diagnosis does not show up on any line in the prioritized list. (“No Liners”)
These are usually related to diagnostic services which are needed to establish a diagnosis. Diagnostic services are covered regardless of where the diagnosis appears (or doesn’t appear) on the [...]
How do I sign up for the provider newsletter?
You can use our sign up form. Previous newsletters can also be found on our provider page.
When using CIM I try to enter a Diagnosis code in the Manage Diagnosis box, it jumps to another code in the drop down-box and ends up with a wrong diagnosis code. What is happening?
When typing in a code, the system will start loading results as you type. If you type too quickly, the system may not be able to process quickly enough. Please double check your entries.
Why is UHA asking for a funded diagnosis?
UHA is following the Oregon Health Plan (OHP) rules which state that covered services are those medically necessary and appropriate health services and items described in the Prioritized List of [...]
