Tools for OHP health plans

Technical assistance for the health and dental plans that coordinate care for over 80 percent of Oregon Health Plan (OHP) clients.

OHP managed care is changing - Learn more about Coordinated Care Organizations.  

Covered services

The Model Contracts describe the services generally covered by contracted plans. To view a copy of the model contracts, contact Katrina Gonzales or Kellie Skenandore of DMAP.

Plan coverage must be comparable to DMAP's fee-for-service coverage.

• The Prioritized List of Services determines DMAP coverage.
• DMAP's General Rules explain fee-for-service coverage.
• The OHP Rules explain plan coverage.
• Also see DMAP's quarterly fee-for-service Fee Schedule.

Mental health drugs  (Excel ) are always billed to DMAP instead of the plan for all OHP members. All other prescriptions are billed to OHP health plans (CCO, FCHP, PCO).

Doing business with DMAP

If you need help with member enrollment issues, contact Client Enrollment Services. For other issues:

Reporting encounter data	Register as an electronic data interchange (EDI) trading partner. Select the 820, 834, 835, 837, NCPDP and Status File transactions. Transactions must comply with national X12 standards, the Oregon Companion Guides, and DMAP's Oregon MMIS Technical Specifications.  Also refer to the Encounter Data Submission Guidelines. Need help? Ask your encounter data liaison.
Receiving payments	Sign up for direct deposit . Need help? Contact Provider Enrollment (800-422-5047).
Keeping informed	Read announcements and managed care service area updates from DMAP Attend OHP public meetings Review OHP contractor workgroup meeting material Need help? Contact your DMAP Account Representative.
Enrolling new providers	Send us a completed Plan Provider Enrollment Request  (DMAP 3108). Fax to 503-378-3074 (Salem) using an EDMS coversheet.  Need help? Ask your encounter data liaison.
​Updating provider files	View our weekly file of active and inactive providers (password required).   Need help? Ask your encounter data liaison.​

Helpful links