Professionally Administered Drug (PAD) Grid
This authorization grid pertains to professionally administered drugs given by healthcare providers in clinical settings, including offices, outpatient hospitals, or home infusion therapy services.
Payspan/Zelis Customer Service FAQs
Frequently asked questions for providers about the transition from Payspan to Zelis electronic payment systems, covering ePayment Center setup, electronic funds transfer, and how to contact Zelis customer service.
OHA Waiver of Liability Form
Oregon Health Plan Client Agreement to Pay for Health Services form, used when a member agrees to pay a provider directly for services not covered by OHP, CCOs, or managed care plans, completed by the rendering provider or facility with the member’s signature.
Provider Update Form
Form for contracted providers to submit updates to their information in the Umpqua Health Network, including address, office hours, credentials, licensure, taxonomy, and Medicare ID changes. Submit completed forms to UHNProviderServices@UmpquaHealth.com.
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.