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OHP eligibility verification


Learn how to find out an OHP client's eligibility for health care benefits.

The General Rules provider guidelines include the Oregon Administrative Rule (OAR) that requires providers to verify eligibility before providing service. 

Remember that coverage of a specific service also depends on its ranking on the Prioritized List of Health Services for the condition being treated. See the Oregon Health Plan rules, OHP Prioritized List page and Benefits and HSC List Inquiry Quick Reference PDF to learn more.

To learn more about verifying eligibility and enrollment for Health Share of Oregon members, visit the Health Share of Oregon website​.

Verification options

Option Getting started Resources
Provider Web Portal
https://www.or-medicaid.gov
After login, click "Eligibility" Eligibility and Copayment Quick Reference PDF and Tutorial PDF
Automated Voice Response
866-692-3864
After login, press 1 for Recipient Eligibility AVR Quick Reference PDF
270/271 Transaction Register for Electronic Data Interchange (EDI) with DMAP or a DMAP-registered clearinghouse and do batch submissions of eligibility inquiries for DMAP to verify within 24 hours. Current EDI trading partners - Request 270/271 access using the EDI Registration Change Request PDF
 
New to EDI?

 

Code lists

Automated Voice Response reads back codes for a client's third-party liability (TPL) carriers, OHP managed care plan(s), and DHS/OHA benefit plans. Use these resources to find out what the codes mean:

  • Insurance Carrier Codes PDF - Provides the name and contact information for each carrier code.
  • OHP Health Plan Codes PDF - Provides the county and plan name for each code.
  • Benefit Plan Codes PDF - Provides benefit description for all benefit plan codes. Codes that indicate medical eligibility (e.g., OHP Plus) are at the top of the list.

 

Need help?

Lost your PIN letter? Need your PIN reset? Call Provider Services at 800-336-6016. Provider Services can reset your PIN for the AVR or Provider Web Portal over the phone during regular business hours.