Some medical services, surgical procedures, and medications require IHN-CCO’s written approval before you can get them. This process is called prior authorization, also called prior approval. It basically means that your provider has to ask permission to prescribe you a drug or have you undergo a treatment, service, or surgery that isn’t covered by your health plan.
Your provider fills out a form requesting permission to give you a certain drug, treatment, service, or surgery. If approved, it will be covered to some extent by IHN-CCO. If not, IHN-CCO may recommend an alternative that is covered, or you may opt to get the drug, treatment, service, or surgery anyway and cover the costs yourself.
IHN-CCO reviews and updates its Prior Approval List annually.
Some medical services, procedures, supplies and equipment require IHN-CCO written approval before being performed or supplied. All coverage is limited by Oregon Administrative Rules and the Oregon Health Evidence Review Commission (HERC) Prioritized list may review and deny services that are not medically appropriate.
IHN-CCO may review and deny services that are not medically appropriate.
Medically appropriate services and medical supplies are considered required for prevention, diagnosis or treatment of a medical or mental health condition or injury, and which are:
Prior Approval List (English)Prior Approval List (Español)
For a complete list of services that require approval, please contact your dental plan directly.
Advantage Dental Services866-268-9631 (TTY 866-268-9617)advantagedental.com
Capitol Dental Care800-525-6800 (TTY 800-735-2900)capitoldentalcare.com
Oregon Dental Services800-342-0526 (TTY 800-342-0526 x711)modahealth.com/ohp
Willamette Dental Group855-433-6825 option 3 (TTY 800-735-1232)willamettedental.com
Some of your prescription drugs may require prior authorization. To find out if your medication requires prior authorization, please search our drug list.
How to Handle Non-covered Services
View OHP’s Prioritized List of Health Services
