Provider Resources & Forms
Provider Handbook [pdf]
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Prior Authorization Flowsheet [pdf]
Please refer to this guide to find out if will need prior authorization for services (not pharmacy). If you have any questions regarding the service you will be requesting, please call the Referral Coordinator at 503-844-8104.
Medical Pre-Authorization list [pdf]
Please refer to this list for information regarding referral requirements. If you have any questions, regarding the service you will be requesting, please call the THA Referral Coordinator at 503-844-8104.
ICD-9 Prioritized List [pdf]
This is the OHP Prioritized List of covered diagnosis. Diagnoses are funded up to line 498. A diagnosis that is higher than line 498 is not a covered diagnosis until further review.
CPT Prioritized List [pdf]
For Outpatient Procedures at Tuality ONLY:
There is no prior authorization required AS LONG AS the diagnosis code(s) and procedure code(s) pair, or are on the same line(s) on the prioritized lists. Tip: Use the search bar in the .pdf document and type in your code to search for lines it falls on. Some codes have more than one line, so please search repeatedly for each code.
THA prior authorization request forms have changed. Please review the new form before adding information. You may now enter your information directly into the PDF and fax to THA directly.
THA Referral Request [pdf]
For Prior Authorizations for services, please fill out our THA Referral Request form and submit this with pertinent chart notes from the referring physician. PAs that are not submitted with chart notes will be returned to the provider.
THA is allowed 14 calendar days to make a pre-determination regarding PA requests; if the matter is urgent (defined in THA Provider Policy Section V-7-II) we will contact the medical provider and attempt to make a determination same day, but no later than two business days.
Early Intervention / ECSE Referral Form [pdf]
Please complete this form when referring a pediatric member to Early Intervention services. Also, keep a copy of this referral form in their medical record for future reference.
For more information regarding standardized screening tools for pediatric members, please visit the Ages and Stages Questionnaire (ASQ) website. THA is providing the ASQ III questionnaires at a discounted rate for providers through 2012. Please call 503-681-1728 for more information.