EOCCO Clinics and Staff,
Welcome to the September 2025 issue of the EOCCO monthly provider newsletter. Below is a preview of the articles you will find in this month’s newsletter:
News from EOCCO:
- EOCCO network changes
- EOCCO medical chart validation
- EOCCO quality improvement office hours update
- Fraud, Waste and Abuse (FWA) provider training
- EOCCO’s 2025 annual workshop
- Reminder: EOCCO full-benefit dual eligible (FBDE) members
From our partners:
- Northwest Regional Newborn Bloodspot Screening (NWRNBS) Program: new disorder to be implemented November 2025
- New OHA-certified Health Care Interpreter Registry file posted
Please let us know if you have any questions, concerns or recommendations. We would love to hear from you!
Email us at: EOCCOproviderinquiry@modahealth.com
Thank you,
Your EOCCO Team
News from EOCCO:
EOCCO network changes
Effective September 1, 2025, Providence Washington is no longer in-network with EOCCO. This includes the following facilities and medical group locations:
- Providence St. Mary Medical Center
- Providence Medical Group locations
- Kadlec Regional Medical Center
- Kadlec Clinic locations
Here is a link to our resource document for referring providers who previously sent services into SE Washington. The high-level list below includes commonly referred services that can be rendered locally, in Oregon. Please visit our website here: EOCCO provider home
The following details reiterate Providence and EOCCO’s commitment to assisting members during this network transition.
Continuity of Care
To ensure minimal disruption to EOCCO members with serious conditions, Providence will provide continuity of care for the following:
- Undergoing a serious and complex condition
- Receiving institutional or inpatient care
- Non-elective surgeries, including post-operative care
- Pregnant and receiving treatment
- Terminally ill and receiving treatment
Additional Services
- Members who have already established specialty services with Providence will continue to be seen through December 31, 2025.
- For members under a Controlled Substance Agreement (CSA), care will continue through December 31, 2025, unless a member has transitioned to another provider prior to that date.
- EOCCO will reassign members to a new in-network Primary Care Provider on September 1, 2025, if a member has not already selected a new PCP.
- Providence will continue to see Full Benefit Dual Eligible members if their Medicare coverage is through a contracted payer.
EOCCO medical chart validation
On a regular basis, EOCCO is required to implement a process to validate the accuracy of claims data received compared to provider charts. EOCCO selects a random sample of paid claims each quarter and requests chart notes, via mail, for those randomly selected claims. EOCCO is requesting your prompt response to these requests. Records not received may result in recovery of payments made. We appreciate your commitment to promoting safe and effective care to our members. If you have any questions or concerns, please contact EOCCO’s Compliance Officer at EOCCOCompliance@eocco.com.
EOCCO quality improvement office hours update
Due to a scheduling conflict, the October EOCCO quality improvement office hours topic has been updated. October’s session will focus on Health-Related Social Needs (HRSN), with our HRSN Program Specialist providing an overview of HRSN benefits, including climate devices, housing, and nutrition.
Upcoming QI Office Hours Schedule
- Tuesday, October 14, 2025, 11:00 a.m. – 12:00 p.m. PST | Health-Related Social Needs (HRSN)
- Tuesday, November 11, 2025, 11:00 a.m. – 12:00 p.m. PST | Meaningful Language Access and Quarterly Language Access Reports
- Tuesday, December 9, 2025, 11:00 a.m. – 12:00 p.m. PST | 2025 Year-End Reporting (Clinical Quality Measures & Prenatal/Postpartum Care)
Click here to register for EOCCO’s Quality Improvement Office Hours.
We look forward to your participation!
Fraud, Waste and Abuse (FWA) provider training
The Oregon Health Authority (OHA) requires all CCOs to provide Fraud, Waste and Abuse (FWA) training to its providers on an annual basis. To help us meet that requirement, EOCCO has posted its provider FWA training on the EOCCO website. We are asking all clinics to review the training and complete and return the EOCCO Provider FWA Training Attestation to EOCCOCompliance@eocco.com.
Please note, if you have received this training through a provider workshop or other venue, you do not need to complete this process. If you have any questions, please contact EOCCO’s Compliance Officer, Nick Gross, at EOCCOCompliance@eocco.com.
EOCCO’s 2025 annual workshop
EOCCO invites you to join us for our annual workshops in Ontario and Hermiston this year. We will spend time discussing Oregon Medicaid and how it is administered through a Coordinated Care Organization (CCO). A wide range of topics will be covered, including Member Eligibility and Plan Types, The Prioritized List of Covered Services, DMAP Registration, Referral and Authorizations process, Claims, Compliance, additional member benefits and HRSN services along with future updates to our program. This workshop is designed for front office, referral and authorization, and billing staff. If you are new to the Medicaid world the information discussed will enhance your knowledge
Locations and dates
- Ontario, Oregon, Tuesday, October 28, 2025, 11:30 a.m. – 1:30 p.m. (MDT)
- Hermiston, Oregon, Wednesday, October 29, 2025, 2:00 pm – 4:00 pm
- Thursday, October 30, 2025, 9:30 – 11:30 a.m. (PST)
- Tuesday, November 4, 2025, 9:30 – 11:30 a.m. (PST)
Please click here for more information and to sign up today! If you need help or have any questions, please email Noah Pietz (noah.pietz@modahealth.com) or Kelly Watanabe (kelly.watanabe@modahealth.com).
Reminder: EOCCO full-benefit dual eligible (FBDE) members
EOCCO full-benefit dual eligible (FBDE) members are those who have Medicare as their primary coverage and EOCCO as secondary coverage. Benefits for these members are coordinated, and they have access to health-related services (also known as flexible services), non-emergent medical transportation (NEMT), and language interpreters at no cost.
Health related services
Health related services are non-covered services under the Oregon Health Plan (OHP) that can help impact members' access to care and improve their health. These services are in addition to covered services and benefits under EOCCO. There are two types of health-related services, flexible services and community benefit initiatives. Providers may ask EOCCO for flexible services that can help improve the health of their members. Some examples of flexible services include:
- Cooking supplies to help make healthy meals at home
- A gym membership if appropriate for a member, or
- Air purifiers for members with asthma or other respiratory conditions.
Members can start the request, but providers will need to approve and submit the request to EOCCO. For more information, please see the flexible services request form.
Non-emergent medical transportation (NEMT)
EOCCO FBDE members can receive free rides to appointments through NEMT services. Rides are available for covered services under OHP. Members can call 877-875-4657, Monday-Friday 8:00 a.m. – 5:00 p.m. PT to request a ride. Please visit EOCCO’s NEMT page for the Free Ride Guide, a list of local phone numbers and list of FAQs.
News from our partners:
OHA Northwest Regional Newborn Bloodspot Screening (NWRNBS) Program: new disorder to be implemented November 2025
The Northwest Regional Newborn Bloodspot Screening Advisory Board approved the addition of Infantile Krabbe Disease (IKD) to the Oregon panel. The NWRNBS Program will implement screening for IKD on Saturday, November 1, 2025.
Krabbe disease is a rare, genetic condition that can damage the nerves affecting a person’s ability to eat, walk, and speak. In the most severe form and without treatment, Infantile Krabbe Disease can progress to death in infancy. The screening test will target detection of the infantile form.
There is no cure for Infantile Krabbe Disease, but treatment can help manage symptoms and improve quality of life. Currently, the only treatment for Infantile Krabbe Disease is a hematopoietic stem cell transplant (HSCT), which should occur before six weeks of life. Due to the need for early treatment, the time from screening to confirmation and treatment must move extremely quickly.
At this time, no action is required. This notice is for awareness only. Please share this update with all relevant staff and providers to ensure they are informed ahead of the November 1st rollout.
As Oregon prepares for implementation, additional resources and educational materials will become available. For more detailed information about IKD, please review the American College of Medical and Genetics and Genomics IKD ACT sheet.
New OHA-certified Health Care Interpreter Registry file posted
The August 2025 Oregon Health Authority Health Care Interpreter (HCI) Registry file has been posted to the EOCCO Incentive Measure webpage under “Meaningful Language Access”. This file contains a list of all active OHA Certified or Qualified Health Care Interpreters in the state of Oregon. Files can be downloaded for your reference and records.
You can also search for OHA Certified or Qualified Health Care Interpreter’s on the Health Care Interpreter Registry webpage.
Questions?
Questions related to incentive measures, health equity, traditional health workers, SDoH, and HIT - Please email EOCCOMetrics@modahealth.com
Questions related to claims and payment information - Please email EOCCOProviderInquiry@modahealth.com
Need to verify if your provider or group NPI is active? Please use OHA’s verification tool
Need to register your practitioner, group or facility? You can find forms on EOCCO.com/Providers/becomeaprovider
If you would like to be added or removed from the email list, please let us know at finn.gornick@modahealth.com
