Tools for providers 

Sign up to receive OHP Tools for Providers email updates 

This page contains information for the health care and service providers who make sure that Oregon Health Plan (Medicaid) clients get the services they need. It includes links to information about how to become an OHP provider, the basic "keys to success" to successfully bill DMAP for claims, and all the policies that providers need to know.

Announcements

Billing information

Back to top 

Electronic Data Interchange (EDI) more 

• How to get started
• How to become an EDI submitter
• Resources and companion guides - How to set up your EDI transactions
• System Alerts

Back to top

Electronic Funds Transfer

To receive your payments from DHS using Electronic Funds Transfer (EFT, or direct deposit), complete this form.

Eligibility verification more 

• Automated Voice Response resources - NEW AVR Guide now available
• General Rules guidelines - (DHS Medical Care IDs, copayment, benefit package information)
• Provider Web Portal resources

Back to top

Forms more

• Forms for applicants 
• Forms for clients 
• Forms for providers, plans and outreach partners 
• Electronic Data Interchange forms 
• More outreach facility forms 
• Other DHS forms 

Fraud and abuse

• Employee Education about False Claims Recoveries (PDF)
• DHS Fraud Reporting and Investigations
• DHS Fraud Referral Database

Back to top

Frequently Asked Questions (FAQs) more 

• Access to care
• Benefit packages
• Copayments
• Electronic Data Interchange
• National Provider Identifier
• Payment Error Rate Measurement (PERM)
• Pharmacy pricing and reimbursement
• Premiums

Back to top

New providers more

• How to enroll as an OHP provider
• Keys to Success--Partnering with DMAP (PDF)
• What provider materials do you need? 

Outreach sites more

• FAQs
• Do's and don'ts
• Forms 

Payment Error Rate Measurement (PERM)

• Learn more about PERM
• Frequently Asked Questions

Back to top
 

Prioritized list, fees, rates and costs more

• Prioritized List of Health Conditions 
• Fee schedule (fee-for-service) 
• Managed Care (capitation rates and per capita costs) 
• Prioritized List of Health Services 

Back to top

Provider guidelines more 

• Current rules (OARs) and guidelines — The rules you need to follow today.
  DME • General Rules • OHP • Pharmacy • more
• Notices of rulemaking, proposed revisions and hearings — Proposed changes to rules in current DMAP programs. Also - how to read proposed rule revisions
• Provider guidelines archive — If you need to resubmit a claim from the past 12 months, make sure you are billing according to the provider guidelines that were available on the claim's date(s) of service.
• Temporary Rules - Just-in-time changes to administrative rules for various programs

Back to top

Provider tax rules and forms

Provider Training more

• National Provider Identifier (PDF)

• EDI Registration Packet (PDF)

• Paper claims tutorials 

• Provider Web Portal eCourse

• What to do after you receive your RA

Back to top