To bill and receive direct reimbursement by DMAP for health care services, enroll with us as an OHP provider, then learn what you need to get started.
If you want to deliver services through an OHP health plan, contact your local coordinated care organization.
If you do not bill DMAP or a plan, but need to be reported in our system for other reasons (such as obtaining Provider Web Portal or Automated Voice Response access, or rendering/ordering/prescribing/referring services for OHP clients), complete our Non-Payable Provider Enrollment Form (DMAP 3113) (Word) (PDF).
If a group or clinic bills for you, you only need to enroll as a non-payable provider using the DMAP 3113 (Word) (PDF). To bill DMAP directly, complete and fax the following forms to 503-378-3074 (Salem) under the EDMS Coversheet (MSC 3970). Include a copy of all documents requested on each form.
Entities, agencies, facilities and organizations
To bill DMAP directly, complete and fax the following forms to 503-378-3074 (Salem) under the EDMS Coversheet. Include a copy of all documents requested on each form.
|Ambulatory surgical center
Family planning clinic
Home health agency
Long-term care facility
Mental health clinic
Public health clinic
Mental health residential treatment facility
Special inpatient care facility
|DMAP 3117 (Word) (PDF)
||Initial enrollment request
OHA 3974 (Word) (PDF)
OHA 3975 (Word) (PDF)
|Behavioral rehabilitation service
||DMAP 3101 (Word) (PDF)|
|Billing Provider/Clinics or Groups Practices
||DMAP 3110 (Word) (PDF) |
If you have rendering primary care providers, submit their attestations to qualifying for the temporary 2-year increase
DMAP 3119 (Word) (PDF)
Durable medical equipment provider
Prosthetics, orthotics personnel
DMAP 3116 (Word) (PDF)
This form is not required for Hearing Aid Dealers or Lifeline Dealers.
|Federally Qualified Health Center
Rural Health Clinic
Tribal health center (Indian Health Services or Tribal 638)
|DMAP 3104 (Word) (PDF)|
|Freestanding Kidney Dialysis Center
||DMAP 3109 (Word) (PDF) |
|Hospital (including hospital psychiatric unit or hospital-based clinic)
||DMAP 3111 (Word) (PDF) |
||DMAP 3112 (Word) (PDF)|
||DMAP 3115 (Word) (PDF) |
||DMAP 3105 (Word) (PDF)|
|Rural Health Clinic with practitioners licensed to dispense medicine
||DMAP 3115R (Word) (PDF) |
||DMAP 3120 (Word) (PDF) |
|Targeted Case Management
||DMAP 3103 (Word) (PDF)|
||DMAP 3118 (Word) (PDF) |
Need to check the status of your enrollment request with DMAP? Try our online enrollment tracking. If you have questions about enrolling with DMAP, call DMAP Provider Enrollment at 1-800-422-5047 or e-mail firstname.lastname@example.org.
- Stay enrolled – Submit updates within 30 days of the change on either the Provider Web Portal Demographic Maintenance panel or DMAP 3035 form (Word) (PDF). Also send us a copy of your licensure renewal when you receive it from your licensing board.
- DHS 189 (Direct Deposit Authorization Form) – Receive your payments securely and electronically. For Medicaid EHR Incentive Program payments, enter the Oregon Medicaid provider number and account information associated with the payee you identified when registering with CMS for EHR incentive payments
- Medical and behavioral health providers: If you have questions about enrolling with a coordinated care organization (CCO), contact the CCO. 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).
- Dental providers: If you have questions about enrolling with an OHP dental plan, contact the plan.