Mental Health Provider
The ICD-10 Prioritized List can be found at the following webpage: http://www.oregon.gov/oha/healthplan/Pages/icd10.aspx
A searchable version of the Prioritized List of Health Services is available here.
- Clinical Guidelines
- Medical Necessity addendum - CATC admission (34 KB)
- Health Share of Oregon Provider Authorization Guides and Forms
- Guide to HSO/ MMH Child and Family Levels of Care
- Level of Care Child and Family Treatment Initial Registration Form
- Level of Care Child and Family Treatment Re-authorization Registration Form
- Level of Care Adult Treatment Initial Registration Form
- Level of Care Adult Continued Treatment Registration Form
Mental health reporting forms
Complaint forms for OHP and non-OHP members are located on the Get Informed page. Forms in additional languages are available upon request.
Mental health provider contract exhibit forms
- Invoice Template - Exhibit 6A (you may request an excel version of the invoice by emailing MHASD business services at: firstname.lastname@example.org)
- Cost Reimbursement Budget - Exhibit 6C
Mental health treatment request forms
To request psychological evaluations, please complete a (PTAR) form and submit supporting clinical documentation.The following information should be included for the request to be considered for review:
1. PTAR with completed supplemental questions.
2. Mental Health Assessment (within last 60 days); updated treatment plan and needs.
3. Submit any additional clinical justification and documentation to support request for authorization.
Please note: MMH authorizes payment at a rate of $110/hour with max of $880 for psychological evaluations.
*Neuropsychological Assessments or assessments related to medical conditions are the responsibility of member's capitated medical plan and requests must be made through medical insurance not behavioral/mental health.
Please submit complete requests to Multnomah Mental Health Utilization Review by secure email to URTeam@multco.us or by fax to 503-988-3137.
Multnomah Mental Health
State and Health Share / Multnomah Mental Health Contracts
- County Financial Assistance Agreement 2015 - 2017
- AMHI Agreement 2015 - 2017
- Multnomah Mental Health / Health Share contract 2014
- Amendment 1 to Multnomah Mental Health / Health Share contract
- Amendment 2 to Multnomah Mental Health / Health Share contract
- Amendment 3 to Multnomah Mental Health / Health Share contract
- Amendment 4 to Multnomah Mental Health / Health Share contract
- Amendment 5 to Multnomah Mental Health / Health Share contract