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For Providers

Together with healthcare providers and professionals, our team is dedicated to providing an integrated approach to deliver quality and cost-effective healthcare services.

The information below will help you with any claims or care management questions or concerns.

Provider Classification – Policy 801 (PDF)

Care Management (Referral/Authorization)

  • Care Management Support: 1-877-261-6991
  • RN Care Manager: 503-261-6000
    Fax: 503-251-6877
  • Detailed information about HRNW’s Referral/Authorization Process is listed in Policy 700 (PDF).
  • Detailed information about HRNW’s Durable Medical Equipment (DME) Process is listed in Policy 729 (PDF)

Care Management Decisions

  • Care Management (CM) decision making is based only on appropriateness of care and service, and existence of coverage. HRNW does not specifically reward practitioners, providers or other individuals conducting care review for issuing denials of coverage or service care. There is no financial incentives for CM decision makers to encourage decisions that result in under-utilization.
  • A physician peer to peer reviewer is available to discuss medical necessity denials. Physician may utilize an appeal process for unresolved differences of option by contacting HRNW.

Claims

  • Customer Service: 503-251-6890 ext 3
  • Fax: 503-261-6020