Learn how to find
an OHP member's eligibility for health care benefits.
How to verify eligibility
DMAP offers three ways for enrolled Oregon Medicaid
providers to access eligibility information for OHP members:
Provider Web Portal - https://www.or-medicaid.gov
After login, click "Eligibility" to get started. To
learn more, see the Eligibility and Copayment
Automated Voice Response - 866-692-3864
After login, press 1 for Recipient Eligibility. To learn
more, see the AVR Quick Reference.
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. To learn more, visit the EDI Web page.
Tools and resources
To learn more about verifying eligibility and
enrollment for Health Share of Oregon members, visit the Health Share of Oregon website.
The General Rules provider guidelines include the Oregon Administrative
Rule (OAR) that requires providers to verify eligibility before providing
Coverage of a specific service also depends on its ranking
on the Prioritized
List of Health Services for the condition being treated.