Care Management Transition of Care Support
Experts to help ease your way
Providence Health Plan Care Management assists members, member representatives, and your providers during the transition from one health plan to another, change in benefit plan or upon termination of a provider’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 you may have during your 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 benefits
- 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 prior authorizations for needed care
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 your transition.
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 one 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 see FAQs below or call us at 503-574-7247 or 800-662-1121 (TTY: 711). Monday - Friday, 8 a.m. to 5 p.m. (Pacific Time), or email Caremanagement@providence.org.
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 benefits or answer any questions you may have. Call Providence Care Management 503-574-7247 or 800-662-1121 (TTY: 800-735-2900), Monday - Friday, 8 a.m. to 5 p.m. (Pacific Time).
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I’m new to Providence Health Plan and in the middle of treatment for a condition.Can you help me understand my new benefits and where to go?
We’ll help you transition your care to providers, facilities, and pharmacies that are in network for your plan. During an active episode of treatment, Care Management will help you gather the necessary information to process your request for continuation of services with your current provider.
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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, you can complete the Transition of Care forms above and Providence Health Plan Care Management will outreach to you. You can also call Providence Health Plan Customer Service for assistance at 503-574-7500 or 800-562-8964 (TTY: 800-735-2900), Monday - Friday, 8 a.m. to 5 p.m. (Pacific Time).
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My provider is out of network with my new benefits. 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 benefits with your provider. If you do not have out of network benefits, you can complete the Transition of Care forms above or contact Care Management for support.
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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'd be happy to assist you. You can complete the Transition of Care forms above or contact Care Management for support.
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I’m not sure how to navigate my new health plan or resources. Can you help?
Explore our Providence Health Plan website. Also, Care Management is here to assist you in navigating your new plan.
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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. You can complete the Transition of Care forms above or contact Care Management for support.
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I have medication(s) that I need. Can you help?
Yes, we’d be happy to help you. Complete the Transition of Care forms above or contact Care Management for support. You can also contact Providence Health Plan Pharmacy Services at 503-574-7400 or 877-216-3644 (TTY: 711), Monday - Friday, 8 a.m. to 5 p.m. (Pacific Time).
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What other resources may be helpful during my Transition of Care?
- myProvidence secure member portal connects you to personalized health plan information such as member ID cards, provider directory, deductible and out-of-pocket maximum progress, and more.
- Providence Health Plan Provider Directory allows Providence Health Plan 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 Plan providers, allowing members to access their Providence health record as well as enables communication with Providence Health Plan associated medical teams. MyChart is also utilized by community partners such as OHSU, Legacy, PeaceHealth, Asante, St. Charles Health, Salem Health, etc.
- Providence Health Plan 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 Health Plan 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, preferred specialty pharmacy, and preferred mail-order pharmacy. Not sure which to use? Refer to our website for more information.
- Swindells Resource Center is a part of Providence Children’s Health. Swindells Resource Center supports parents and caregivers of children who have special health, behavioral or developmental needs. Swindells offers (or provides) video resources, information, and education to communities throughout Oregon and southwest Washington.
Note: Submitting a transition of care form 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 form 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.