Care Management Transition of Care Support
Experts to help ease your way
Providence Care Management assists members, member representatives, and practitioners during the transition from one health plan to another, change in benefit plan or upon termination of a practitioner’s relationship with Providence; each is reviewed on a case-by-case basis. Care Management’s Transition of Care Forms (questionnaire and release of information) are designed to alert our team to needs a member may have during their transition.
Support when needed
Not all members need Care Management Transition of Care support, but it may be helpful when:
- You are a current member with a change to your coverage.
- You are a new member and your current physical health or behavioral health provider is out of network and you do not have out of network benefits.
- You are a new member and have an upcoming pre-approved procedure, treatment, and/or pregnancy.
- You are a new member and need help with referrals and/or prior authorizations for needed care.
How to get started
To submit your Transition of Care Request, complete the following:
- Complete the Transition of Care Questionnaire and Consent for Release Information here.
- Submit forms in any of the following ways:
- Mail: 3601 SW Murray Blvd., Beaverton OR 97005 Attn: Care Management Transition of Care
- Email: Caremanagement@Providence.org
- Fax: 503 -574-8171
For more information or additional questions, read our FAQs below or contact us by phone at 503-574-7247 or 800-662-1121 (TTY: 711) Monday- Friday (8-5 PST) or email Caremanagement@Providence.org
How Care Management can help
Care Management helps members with clinical and non-clinical needs by:
- Providing education about plan services and processes.
- Assistance finding and establishing with new physical health or behavioral health providers.
- Navigation to Pharmacy, Durable Medical equipment, Diabetic supplies, or other services or resources.
- Care Coordination between multiple providers.
- Any other healthcare navigation support needed during this transition.
Frequently asked questions
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I’m going to have a new health plan. I’m not sure what my next steps are. What should I do?
We are here and happy to help you navigate your new plan or answer any questions you may have. Call us at Providence Care Management: Monday – Friday, 8:00 am – 5:00 pm (PST): (503) 574-7247 or 800-662-1121 (TTY: 800-735-2900)
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I’m new to Providence Medicare Advantage Plans and in the middle of treatment for a condition.
Can you help me understand my new coverage and where to go?We’ll help you transition your care to providers, facilities, and pharmacies that are in your plan. If your treatment is active, we will help you gather the clinical information necessary to finish your treatment with your current provider under our Transition of Care Process.
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I'm not sure if my provider(s) is in or out of network.
You can access the Providence Provider Directory to review providers that are in your network. If you are having difficulty, please fill out the Transition of Care forms above and Providence Care Management will reach out to you. You can also call Providence Customer Service for assistance Monday – Friday, 8:00 am – 8:00 pm (PST) at 503-574-8000 or 800-603-2340 (TTY:711)
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My provider is out of network with my new coverage. Can I continue seeing the provider?
If you’re your plan has out of network benefits, they will apply to your visits moving forward. Make sure to update your new insurance information with your provider. If you do not have out of network benefits, please submit the Transition of Care forms above so that we can assist you.
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Do I need to choose Providence providers?
Each Transition of Care need is different and as such, each member’s needs are evaluated on a case by case basis. We would love to assist you. Submit the Transition of Care forms above and Providence Care Management will outreach to you.
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I’m not sure how to navigate my new health plan or resources. Can you help?
Explore our Providence Health Assurance website. Also, Care Management is here to assist you in navigating your new plan.
Fill out the Transition of Care forms above and Providence Care Management will outreach to you. -
I have gotten approval for an upcoming procedure from my previous health plan coverage. What do I do now?
We will try to help you proceed as planned. Fill out the Transition of Care forms above and Providence Care Management will outreach to you.
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I have medication(s) that I need. Can you help?
Yes, we’d be happy to help you. Submit the Transition of Care forms above and Providence Care Management will outreach to you. You can also contact the Providence Pharmacy Services directly at 503-574-7400 or 877-216-3644 (TTY: 771).
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What other resources may be helpful during my Transition of Care?
- MyProvidence is the site that Providence members can log connects to member ID, benefit information such as deductibles, referrals, provider directory, etc.
- Providence Provider Directory allows Providence Health Assurance allows members to enter their member ID to search for in network providers. If your provider or facility is not listed it is likely out of network, the zip code entered needs to be changed, or it has been misspelled.
- Providence MyChart is used for medical management with Providence Health Assurance providers. It allows members to access their Providence health record as well as enables communication with Providence associated medical teams. MyChart is also utilized by community partners such as OHSU, Legacy, PeaceHealth, Asante, St. Charles Health, Salem Health, etc.
- Providence Health Assurance website provides information and navigation support using your health plan, which includes; paying bills, accessing forms and documents, and all other value-adds and resources available with your health plan.
- Providence offers services including: Hospitals, Immediate Care, Express Care at Walgreens (in special locations in Oregon and SW Washington), Express Care Virtual (accessible through the Providence app on your smartphone), Primary Care, Specialty Care, preferred laboratories, preferred retail pharmacies, a preferred specialty pharmacy, and a preferred mail-order pharmacy. Not sure which to use? Refer to our website for more information.
Note: Submitting a transition of care packet is not required. Members can choose to see providers at out of network rates if they have out of network benefits. Submitting a transition of care packet does not guarantee in-network rates. If a benefit exception request is submitted and in-network rates are approved, members may still be liable for any balance billing by the out of network provider. Decisions are based on medical necessity and not a guarantee of payment for services. Payment is based on eligibility and benefits at the time of service.
Out-of-network/non-contracted providers are under no obligation to treat Plan members, except in emergency situations. Please call our customer service number or see your Evidence of Coverage for more information, including the cost-sharing that applies to out-of-network services.
Webpage is current as of: 10/02/2024