NCQA is governed by a Board of Directors that includes employers, consumer and labor representatives, health plans, quality experts, policy makers and representatives from organized medicine.
Resources for you and your patients
Claims / Appeals
Hints to reduce claims processing time, information on filing electronic claims, and common explanations for disputed claims.
Referral and Authorization Guidelines
Guidelines for referrals and authorizations.
Policies / Manuals
ODS policies and provider manuals for healthcare providers.
Benefit Tracker
Online tool providing eligibility look up, claims status, referral inquiries and more.
Medical Necessity Criteria
Criteria guide for providing medical services.
Forms / Samples
Commonly used forms and samples of ODS ID card and Explanation of Benefits.
Frequently Asked Questions
Answers to questions about ODS Commercial Plans and the Oregon Health Plan (OHP).
Disease Management / Health Coaching
Useful information on disease management.
Behavioral Health
Information for medical and behavioral health providers.
Healthcare Coordination
Care coordination nurses work directly with facilities and providers to facilitate preauthorization of scheduled procedures, inpatient stays and follow up care, and follow members during urgent emergent admissions.
myODS
myODS gives members access to a website that's been uniquely tailored to your their plan. myODS is available 24 hours a day, 7 days a week allowing your patient to manage their plan as they see fit.
Quality Improvement Programs
Learn how we evaluate our services as part of our effort to make healthcare easier for you and better for our members.
Quality Improvement Initiatives
ODS is committed to providing high-quality healthcare services for all our members. We continually monitor and evaluate our services as part of our effort to make healthcare easier for you and better for our members.
Policy on Healthcare Use
ODS policy to encourage appropriate utilization and discourage underutilization of services.
Member Rights and Responsibilities
Theses statements reflect ODS’ commitment to treating members respectfully and outline its expectations of members’ responsibilities.