March 2, 2007
RE: Important Information on CCHP & PHTech Partnership
Dear Clinic Administrator:
As we discussed during our December provider meetings, Clear Choice Health Plans partnered with Performance Health Technology (PHTech) effective January 1st, 2007 to administer our COIHS claims and customer service. One significant reason that we partnered with PHTech is because of their experience and ability to administer the Oregon Health Plan according to the benefit structure of our State’s Medicaid plan. To ensure that your services are payable under the OHP benefit design, please remember the following:
Criteria for COIHS Claims Adjudication:
• All benefits are subject to the OHP “line”. Use line-finder or the line search on the Clinical Integration Manager (CIM) program accessible from PHTech.
• Follow-up Specialist visits require prior-authorization.
• All procedures are subject to the COIHS prior-authorization grid (http://www.clearchoicehp.com) click on “Provider”.
COIHS Duplicate claims submissions:
Some providers are submitting duplicate claims days apart from each other. This duplicate volume significantly impacts the work flow resulting in delays. Please access the CIM system at https://coihs.phtech.com to monitor your claims online. If you do not have access to CIM, contact one of our Provider Relations Representatives at (888) 863-3637 or (541) 385-5315.