The provider manual is a reference tool for providers and contains important information for providers and office staff for the delivery of health care for WVCH CCO members.
IMPORTANT UPDATE FOR BEHAVIORAL HEALTH SERVICES
- Assistance with authorization submission, status or care coordination
503-365-6531 or 503-371-7701 Opt 2, Opt 4
- General questions related to Behavioral Health Authorization and Care Coordination Transition
- Members needing to access services
- Members with challenges accessing services or needing additional support will be routed to the WVP Behavioral Health Coordinators
- Provider fax number for authorization submission
Download Current Provider Manual here:
Supplements to Provider Manual:
Download Authorization forms here:
The medications on the Willamette Valley Community Health (WVCH) formulary are grouped into categories depending on the type of medical conditions that they are used to treat. Medications are listed in alphabetical order in the first column of the drug table. Brand name drugs are capitalized, and generic drugs are listed in lower case italics.
Starting September 3, 2019, the Oregon Health Authority (OHA) and WVCH will deny prescriptions written by non-Oregon Health Plan (OHP) providers
Federal Medicaid program integrity regulations require all providers who write prescriptions for Medicaid members to be enrolled as a Medicaid provider in the member’s state. Otherwise, Medicaid cannot cover the prescription. This is true even if the provider is enrolled as a Medicaid provider in a different state.
Starting September 3, 2019, OHA and WVCH will deny prescription claims that do not contain the National Provider Identifier (NPI) of an active, enrolled Oregon Medicaid provider.
How to enroll
To enroll with OHA, visit OHA's Provider Enrollment page.
To enroll with a CCO, contact the CCO.
Download Formularies here:
|April 25, 2019||WVCH Formulary Q1 2019||Updated||Download|
|March 8, 2019||WVCH Formulary Q1 2019||Updated||Download|
|February 8, 2019||WVCH Formulary Q1 2019||Updated||Download|
|January 21, 2019||WVCH Formulary Q1 2019||Updated||Download|
|December 20, 2018||WVCH Formulary Q4 2018||Updated||Download|
|July 1, 2017||Medicaid MedImpact Formulary||New formulary for WVCH members – Effective 03/28/2018||Download|
|January 01, 2016||Medicaid WRAP/D-Excluded Formulary||New formulary for members who have Medicare as their primary insurance and WVCH as their secondary (dual eligible members) – Effective 01/01/2016||Download|
Formulary change log:
|April 6, 2019||Download|
|March 9, 2019||Download|
|March 1, 2019||Download|
|March 17, 2018||Download|
Download the Medicaid Preferred Drug List here:
Prior Authorization Criteria
Medications with Drug-Specific Criteria for Prior Authorization.
|Biologics For Rheumatic Disease - Non-TNF||Download|
|Biologics For Rheumatic Disease - TNF||Download|
|Head Lice treatment||Download|
|Hepatitis C Direct-acting Antivirals||Download|
|Inflammatory Bowel Disease||Download|
|LABA-ICS Prior Authorization||Download|
|Levetiracetam ER (Keppra Xl) And Oxcarbazepine (Solution And Oxtellar XR)||Download|
|Opioids - Conditions Of The Back And Spine||Download|
|Proton Pump Inhibitor||Download|
|Ranexa And Bystolic||Download|
|Severe Inflammatory Skin Conditions||Download|
|Stimulants For ADHD||Download|