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. Starting Jan. 1, you can find out copayment amounts and covered services for each benefit plan.

• Verification options
• Code lists
• Need help?

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  to learn more.

Verification options

Option	Getting started	Resources
Provider Web Portal https://www.or-medicaid.gov	After login, click "Eligibility"	Eligibility and Copayment Quick Reference  and Tutorial
Automated Voice Response 866-692-3864	After login, press 1 for Recipient Eligibility	AVR Quick Reference
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    New to EDI? Ask a DMAP-registered clearinghouse about 270/271 services, or Submit the EDI Registration Packet to EDI Support Services today.

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  - Provides the name and contact information for each carrier code.
• OHP Managed Care Plan Codes  - Provides the county and plan name for each code.
• Benefit Plan Codes  - 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.