Text Size:   A+ A- A   •   Text Only
Site Image

OHP eligibility verification

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 Quick Reference.

Automated Voice Response - 866-692-3864

After login, press 1 for Recipient Eligibility. To learn more, see the 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. 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 service. 

Coverage of a specific service also depends on its ranking on the Prioritized List of Health Services for the condition being treated.

271 Supplement - Carrier Code ListProvides the name and contact information for each carrier code that AVR may read for an OHP member.
271 Supplement - EB05 Benefit DescriptionsProvides benefit description for all benefit plan codes that AVR may read for an OHP member. Codes that indicate medical eligibility (e.g., OHP Plus) are at the top of the list.
DMAP Registered Clearinghouse ListA list of EDI clearinghouses that are registered as current trading partners with DMAP. This list does not imply any endorsement by DMAP of services or products listed.
How to use Benefits and Prioritized List inquiryUse this inquiry to make sure your patient is eligible to receive specific services under their benefit package or for their specific condition.
Oregon Medicaid Third Party Liability Requirements
Plan Codes CrosswalkProvides the county and plan name for each plan code listed for an OHP member.
Sample HealthCare.gov eligibility confirmation letterStarting November 15, 2014, OHP providers may accept this letter as proof of eligibility effective for the application date listed on page 1.
Sample Oregon Health ID (formerly Medical Care ID)Use the information on this ID to correctly enter client's name, date of birth and ID for eligibility verification.
Verifying OHP eligibility and enrollmentThis self-paced guide explains how to check eligibility using the Provider Web Portal.