January 1, 2007, Clear Choice Health Plans assumed administration of the OHP Standard population. As you are likely aware, the OHP Standard is a benefit program that covers only a limited number of uninsured adults who are not eligible for traditional Medicaid programs. The OHP Standard benefit package does not cover some services covered by the OHP Plus benefit package. Please visit the following website:
http://dhsforms.hr.state.or.us/Forms/Served/HE9035.pdf please see page 17
For instance, therapies and hospital care is either significantly limited or not covered in the OHP Standard benefits. The COIHS prior authorization grid applies to both our OHP Standard and OHP Plus populations AND is subject to benefits. Practices and facilities should obtain specific wavers if services are not covered benefits under the member’s plan.
If you have any questions, please call our Provider Relations Department at (541) 385-5315 or (800) 863-3637.