Frequently asked questions: OHP service delivery
Learn more about how OHP clients can access health care services.
If you have questions about service delivery not answered on this page, go to the Contact Us page and send your question to the appropriate DMAP contact, or contact the appropriate plan.
Q. What plans work with OHP?
A. To find out about the plans in your area, go to the OHP Medical and Dental Plans by County page. You can also look at contact information for Fully Capitated Health Plans, Physician Care Organizations, Dental Care Organizations and Mental Health Organizations.
Q. How can OHP clients find a health care provider?
A. Clients in an OHP plan can call the plan to get a list of providers currently accepting new patients. Some plans have online provider directories.
Clients not in a plan must call health care providers directly to out if they accept OHP (Medicaid) patients.
Q. Can clients in an OHP plan seek services from a Federally Qualified Health Center (FQHC) or Rural Health Clinic (RHC)?
A. Yes, but only when the FQHC or RHC is part of their plan’s provider panel.
Q. Are FQHCs and RHCs required to charge copayments to OHP plan members?
A. Yes. See OAR 410 Division 147 for useful information on this topic.
Q. What happens when an OHP plan member seeks services from a provider that has not been authorized by the plan?
A. OHP plans approve services for their members. They are not obligated to pay providers for care that has not been approved by the plan (unless it is an emergency). This is true even if the provider collected a copayment.
The provider should always ask clients for their Oregon Health ID (formerly Medical Care ID) before serving them, then verify eligibility, benefit package and plan enrollment to determine who authorizes services (DMAP or the plan). Providers can use Automated Voice Response or the Provider Web Portal to do this.
Q. What are the advantages of managed or coordinated care?
A. For providers:
- Higher reimbursement. Plans usually pay more for services rendered to OHP patients than DMAP does.
- Access to highly developed systems. Plans have continuous quality improvement practices. Access to those resources can help providers address issues facing their patients.
- Access to a network of health care providers. If you’re not in a plan, you must call health care providers yourself to find a provider taking new Medicaid patients.
- Access to preventive services. Plans offer prevention programs (e.g., tobacco cessation), which may be easier to access than if you are not in a plan.
- Increased Quality of Care. Plans have systems for improving the quality of care for all of its members