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Learn how the Prioritized List of Health Services helps determine what services the Oregon Health Plan (OHP) covers.
For detailed information about the creation of the Prioritized List, see the Health Evidence Review Commission's (HERC) Brief History of Health Services Prioritization in Oregon or the biennial reports to the Oregon legislature on the HERC reports page.
The Oregon Health Evidence Review Commission (HERC) ranks health care condition and treatment pairs in order of clinical effectiveness and cost-effectiveness.
The Prioritized List emphasizes prevention and patient education. In general:
Effective Jan. 1, 2018, OHP covers Prioritized List lines 1 through 469.
Use the following links on the HERC website. You can also Subscribe to receive email notifications from HERC whenever Prioritized List information changes or view all recent HERC updates.
For OHA policies related to Prioritized List coverage or exclusions, see the General Rules, Oregon Health Plan rules, and the provider guidelines specific to your program.
To find out whether a specific procedure is potentially covered according to the Prioritized List, providers can use the HSC List inquiry on the Provider Web Portal at www.or-medicaid.gov or call the OHP Code Pairing and Prioritized List Hotline at 800-336-6016.
For more information about the Prioritized List, visit the Health Evidence Review Committee's Prioritized List of Health Services page.
Subscribe to receive updates from HERC when they occur.
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