VISION BENEFIT CHANGES

Dear Valued Providers,

Due to recent changes to routine vision coverage, SWOIPA would like to take the opportunity to provide clarification regarding the in-network vision benefits. Effective immediately, SWOIPA has revised its coverage for vision claims in accordance with

OAR 410-140-0140 to include routine vision exams for adults once every 24 months.

FRAUD, WASTE, AND ABUSE (FWA) TRAINING

Advanced Health is committed to comply with the terms and conditions in the Program Integrity section of our CCO Contract with the Oregon Health Authority. The Program Integrity section of our CCO Contract, or “Section 9” sets forth our State and federal requirements related to preventing, identifying, and reporting instances of potential FWA. One of these requirements is to provide annual training to our employees, subcontractors, and participating providers regarding our FWA Policies and Procedures, including whistleblower protections. Realizing that our providers often have full schedules, we have developed a brief presentation of our FWA program which may be viewed at your convenience and found on our website HERE. We strongly encourage each of our participating providers to view this power pointe presentation as well as use Advanced Health’s 2023 Compliance and FWA Handbook as a resource. Contact information for our Compliance Department may be found in our Handbook, and we encourage and appreciate questions or concerns from our provider community.

Michael C. Hale, BSN, JD, Chief Compliance Officer, Western Oregon Advanced Health, LLC

ADVANCED HEALTH FLEX FUND - NEW PROCESS

A new Flex Funds Process has been created for submitting Flex Fund Requests. Effective November 6, 2023 Providers will now be required to submit electronically through the provided link, www.docshp.com/flexfund/. Members will be able to submit a physical Flex Fund Form if they are unable to submit it electronically. Members can call Advanced Health Customer Service for help if needed.

ADVANCED HEALTH OFFERS CULTURAL COMPETENCY TRAINING TO IMPROVE CARE

As part of our commitment to high-value healthcare, we continue to provide cultural competency training and resources for the Advanced Health Provider Network and their staff. Cultural competency training is a foundational component of our overall strategy to address and eliminate health disparities, especially those based on race, ethnicity, language-barriers, gender, and sexual orientation. 

OHA Redetermination

OHA wants Oregon Health Plan (OHP) members to know that health coverage renewals have resumed as of April 1. While most people will continue to qualify for existing benefits, OHA is required to review eligibility for all 1.47 million OHP members by June 2024.

Members will receive a notice between April 2023 and January 2024.