Want to become an OHP provider?

Go to DMAP's Provider Enrollment page.

If you were denied participation in an OHP medical plan's provider network, read about the OHA Provider Discrimination Review process and form (Word) (PDF).

Billing information

• Common FFS billing errors 
• Billing tips - How to submit claims to DMAP
• Free provider training - Learn to bill using the Provider Web Portal
• How to read a Remittance Advice
• Program-specific rules and supplemental information
• What are DMAP's maximum allowable fee-for-service rates?

Client eligibility and enrollment

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• Automated Voice Response quick reference  - 866-692-3864
• Provider Web Portal quick reference 
• General Rules guidelines - Oregon Health IDs, copayment, benefit package information
• Eligibility verification tutorial
• Oregon Health ID sample

Copayments

• Frequently asked questions
• Eligibility verification options and copayment information
• How to verify copayments 

Covered benefits

• Benefit packages: Frequently asked questions
• Fee-for-service preferred drug list
• Tobacco Cessation Services  2011 Survey - Summary of services provided by OHP medical and dental plans.
• Oregon Health Plan benefit packages 
• OHP Dental Benefits - In English  and Spanish 
• Prioritized List of Health Services
• Provider guidelines

Direct Deposit

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

Electronic Data Interchange (EDI)

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• Administrative simplification
• How to get started
• HIPAA X12 5010 transition
• Resources and EDI standards - How to set up your EDI transactions
• Registration forms

Forms

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Make sure to refer to your provider guidelines for the forms required for your program.

• DMAP/OHP forms
• Electronic Data Interchange forms
• Other DHS/OHA forms
• Provider enrollment forms

Fraud and abuse

• Employee Education about False Claims Recoveries 
• DHS Fraud Reporting and Investigations
• DHS Fraud Referral Database
• General Rules provider guidelines

Frequently Asked Questions (FAQs)

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• Benefits
• Complaints and appeals
• Copayments
• Eligibility
• HIPAA X12 5010 transition
• Medicaid EHR Incentive Program
• Medical payment recovery
• National Drug Code reporting
• National Provider Identifier
• Pharmacy pricing and reimbursement
• Premiums
• Provider Web Portal
• Service delivery

ICD-10 Standards

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• CMS ICD-10 industry e-mail updates 
• ICD-10 provider resources
• Oregon Medical Association ICD-10 webpage
• Take our ICD-10 readiness survey
• View Day 1 and Day 2 of OHA's ICD-10 Webinar

National Provider Identifier

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• Frequently asked questions
• NPI look-up - NPIs are required on all prescriptions
• To update or verify the NPI and taxonomy information associated with your Oregon Medicaid provider number, contact Provider Enrollment (800-422-5047).

New providers

• How to enroll as an OHP provider
• Keys to Success - Partnering with DMAP 
• Learn how to verify OHP eligibility
• Sign up for direct deposit and look into electronic billing
• Sign up for OHP updates for rules, guidelines, resources and more
• What provider materials do you need?

If you were denied participation in an OHP medical plan's provider network, read about the OHA Provider Discrimination Review process and form (Word) (PDF).

Outreach sites

Providers of direct medical services may contract with DMAP to help enroll patients in Oregon's state health coverage programs such as Healthy Kids and OHP Plus. Patients who receive an application and get help filling out the application are more likely to get coverage. Please find more information about this program on the Healthy Kids Provider Outreach Sites page.

Patient-Centered Primary Care Homes (PCPCH)

Information on application, recognition, payment, and more.

• PCPCH rules
• PCPCH Program rules (application and recognition) - See Chapter 409, Division 55 of the Oregon Administrative Rules (OARs).
• PCPCH Medicaid supplemental payment (OHP provider qualification and enrollment criteria) - See OAR 410-141-0860 of the Oregon Health Plan (MCO and CCO) rules.
• PCPCH rules specific for FQHC/RHC and AI/AN providers - See FQHC/RHC rules (410-147-0362) and AI/AN rules (410-146-0020).
• PCPCH for providers

PERM (Payment Error Rate Measurement)

PERM is a federally mandated review of Medicaid and CHIP claim payments. Each state is reviewed once every three years. Oregon's next PERM cycle begins September 2010 for FFY 2011 (Oct. 1, 2010 to Sept. 30, 2011).

• Learn more about PERM
• Frequently Asked Questions
• CMS video - Responding to Medical Documentation Requests

Pharmacy program information

• Pharmaceutical services provider guidelines - Rules and resources for pharmacies, prescribers and drug manufacturers
• 7/11 carveout drug list (Excel) | (PDF)
• Clinical information for prescribers
• Epocrates Rx - Free point of care access on your mobile device to the OHP Preferred Drug List and most plan formularies
• Frequently asked questions about drug pricing and reimbursement
• Medicare Part D information 
• Preferred Drug List
• Quick reference for pharmacies

Prior authorizations

• Prior authorization handbook 
• Contact information for fee-for-service requests 
• EDMS Coversheet - Use for each PA request sent to DMAP 
• Program-specific instructions
• Request form for prescriptions and oral nutritional supplements 
• Universal PA Request Form - instructions 

Prioritized list

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• Current Prioritized List
• Past Prioritized Lists
• Pending changes to the Prioritized List
• Recent changes to the Prioritized List
• Web portal HSC List Inquiry  

Provider guidelines

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• Oregon administrative rules, rulebooks, and guidelines
• Notices of rulemaking, proposed revisions and hearings
• Temporary rules - (certificates of filing)

Provider Web Portal

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• Sign in at https://www.or-medicaid.gov
• Contact team.provider-access@state.or.us (800-336-6016) for PINs or password resets
• Provider Web Portal training - Free videos, guides and Webinar sign-ups
  
• Handbooks and tutorials for Web billing
• Quick references for account setup, eligibility, HSC list inquiry

Remittance Advice

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• Common FFS billing errors 
• How to read a Remittance Advice 

Third-party liability (TPL)

• Learn how to bill for clients with TPL  using the Provider Web Portal
• Phone numbers for the TPL carriers currently on file with DMAP 
• Report TPL to DHS using the DHS 415H 
• See your specific provider guidelines and DMAP's General Rules to learn more.
• What happens when TPL isn't billed first?

Training

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• All OHP provider training resources by topic
  
• ICD-10 conference – Day 1 and Day 2
  
• Medicaid EHR Incentive Program (video)
  
• OHP provider training videos on OHA’s YouTube channel
  
• PERM (video)
  
• Provider Web Portal training - videos, guides and Webinar sign-ups
  

When you need help

• About DMAP Provider Services - Learn what PSU can and cannot do
• DMAP Provider Contacts  - Phone numbers and other contact information for fee-for-service providers