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How to become an Oregon Health Plan provider

National Provider Identifier (NPI) requirements

All health care providers subject to NPI requirements must provide their 10-digit NPI when enrolling as an Oregon Medicaid provider. (Providers not subject to NPI, such as transportation providers, are not required to provide an NPI.)
  • To get an NPI, apply online at the National Plan and Provider Enumeration System (NPPES) website.
  • To look up your NPI information, use the NPI Registry.

If you want to enroll with the Oregon Health Authority:

Use the drop down box below to select the type of “Provider description” that matches you or the services you provide.

  • Complete and fax all forms and documentation listed for your description under an EDMS Coversheet (MSC 3970). Requests submitted without the EDMS Coversheet will not be processed or returned to you. Learn more about using the EDMS Coversheet.
  • If you are an out of state provider (more than 75 miles outside the Oregon border) seeking payment for services to OHP members, also include the claim you are seeking payment for.
  • If you do not bill us, but need to be reported in our system for other reasons (such as obtaining Provider Web Portal or Automated Voice Response access, or rendering/ ordering/ prescribing/ referring services for OHP members), select "Non-Payable Provider" from the drop down box below.
All forms are in PDF.

Provider Description
  
Required Forms
Required Documents
  
Pharmacy
48Copy of current license showing authority to practice as this provider type, IRS letter
ABA Board-Certified Behavioral Analyst (BCBA)
33 (specialty 374)Copy of Behavior Analysis Regulatory Board (BARB) licensure, Copy of current license showing authority to practice as this provider type, SSN documentation
ABA Board-Certified assistant Behavior Analyst (BCaBA)
33 (specialty 375)Copy of Behavior Analysis Regulatory Board (BARB) licensure, SSN documentation
ABA Behavioral Analyst Interventionist (BAI)
33 (specialty 376)Copy of Behavior Analysis Regulatory Board (BARB) registration, SSN documentation
ABA - Other licensed providers
33 (specialty 377)Copy of current license showing authority to practice as this provider type, SSN documentation
ABA Therapist pending BARB registration (Temporary enrollment through 12/31/15)
33 (specialty 378)Copy of current license showing authority to practice as this provider type, SSN documentation
ABA Organization
33 (Specialty 379)Copy of Behavior Analysis Regulatory Board (BARB) licensure, IRS letter
Substance Use Disorder Certified Recovery Mentor
13Copy of OEI or ACCBO certification, SSN documentation
Peer Wellness Specialist
13Copy of OEI certification
Doula
13Copy of OEI certification
Pharmacist Prescribing Hormonal Birth Control (to bill OHA directly)
50 (specialty 109)Copy of certification, Copy of current license showing authority to practice as this provider type
Pharmacist (services billed to OHA by pharmacy)
50Copy of certification
Behavioral Health Certified Peer Wellness Specialist
13Copy of OEI certification, SSN documentation
Medical Electrolysis Provider
21 (specialty 140)Copy of current license showing authority to practice as this provider type, SSN documentation
Behavioral Health LPC Registered Intern
33Copy of board-approved supervision plan, Copy of current registration, SSN documentation
Behavioral Health LMFT Registered Intern
33Copy of board-approved supervision plan, Copy of current registration, SSN documentation
Behavioral Health Registered Intern - ACSW
33Copy of board-approved supervision plan, Copy of current registration, SSN documentation
Behavioral Health Registered Intern - Licensed Psychologist Associate Independent - LPAI
33 (for billing behavioral health services) or 53 (for billing administrative exams/reports)Copy of current license showing authority to practice as this provider type, SSN documentation
Behavioral Health  - LMSW
33Copy of current license showing authority to practice as this provider type, SSN documentation
Behavioral Health Registered Intern - Psychologist Associate Resident
33 (for billing behavioral health services) or 53 (for billing administrative exams/reports)Copy of board-approved supervision plan, Copy of current license showing authority to practice as this provider type, SSN documentation
Behavioral Health - Registered Bachelor of Social Work
33SSN documentation
Acupuncturist
02SSN documentation
Ambulatory Surgical Center
05IRS letter
Personal Care Attendant
30Copy of Social Security card, Fitness determination, I-9 form
Audiologist
45Copy of current license showing authority to practice as this provider type, SSN documentation
Behavior Rehabilitation Services(counties that provide local match funding)
06IRS letter
Behavioral Health Adult Foster Home
33 (specialty 450)
OHA 3972, OHA 3973 - to enroll using SSN, OHA 3974 - to enroll using EIN, OHA 3975
Copy of OHA certification, IRS letter, SSN documentation
Behavioral Health Certified Peer Support Specialist
13Copy of OEI certification, SSN documentation
Behavioral Health Habilitation Provider
33
OHA 3972, OHA 3973 - to enroll using SSN, OHA 3974 - to enroll using EIN, OHA 3975
Fitness determination or copy of license, Letter of approval from OHA-certified Mental Health Program
Behavioral Health Licensed Residential Treatment Home or Facility
33Copy of current license showing authority to practice as this provider type, IRS letter
Behavioral Health Student Intern (Masters)
33Copy of letter from educational program, Fitness determination, SSN documentation
Billing Provider (clinic/group billing)
09IRS letter
Birthing Center
08IRS letter
Behavior Rehabilitation Services (provides local match funding)
06IRS letter
Chiropractor
16Copy of current license showing authority to practice as this provider type, SSN documentation
LTC Nursing Services (formerly Contract RN)
86Copy of current license showing authority to practice as this provider type, DHS/APD authorization and contract number, SSN documentation
Copy Services
12IRS letter
Dental Hygienist
18SSN documentation
Dentist
17SSN documentation
Denturist
20SSN documentation
Direct Entry Midwife
41Copy of current license showing authority to practice as this provider type, SSN documentation
Dispensing Optician (Individual)
44Copy of current license showing authority to practice as this provider type, SSN documentation
Durable Medical Equipment (DME)
36IRS letter, Medicare information, Surety bond (unless exempted)
Emergency Response (Lifeline)
92IRS letter
Family Planning Clinic
22IRS letter, Pharmacy license (if applicable)
Federally Qualified Health Center (FQHC)
15HRSA grant designation, IRS letter, Medicare cost report
Hearing Aid Dealer
23SSN documentation
Home Health Agency
24IRS letter, Medicare information
Hospice
27IRS letter, Medicare information
Hospital
26IRS letter, Medicare information
Independent Diagnostic Testing Facility
09IRS letter, Medicare information
Independent Laboratory
29IRS letter
Kidney Dialysis Center (Renal Disease Clinic)
32IRS letter
Licensed Clinical Social Worker (only for billing exams/reports requested by DHS/OYA)
69Copy of current license showing authority to practice as this provider type, SSN documentation
LTC Nursing Agency
88DHS/APD authorization and contract number, IRS letter
Behavioral Health LCSW
33Copy of current license showing authority to practice as this provider type, SSN documentation
Behavioral Health LFMT
33Copy of current license showing authority to practice as this provider type, SSN documentation
Behavioral Health LPC
33Copy of current license showing authority to practice as this provider type, SSN documentation
Behavioral Health Outpatient Program(employs licensed staff exclusively)
33IRS letter, List of licensed staff that includes credentials, Statement that facility will only employ licensed staff, Statement that facility will seek OHA certification before employing unlicensed staff
Behavioral Health Outpatient Program (employs unlicensed staff)
33Copy of OHA certification, IRS letter
Behavioral Health PMHNP
33Copy of current license showing authority to practice as this provider type, SSN documentation
Behavioral Health Psychiatrist
33Copy of current license showing authority to practice as this provider type, SSN documentation
Behavioral Health Psychologist
33Copy of current license showing authority to practice as this provider type, SSN documentation
Behavioral Health QMHP and QMHA
33

​​OHP 3113

SSN documentation
Mobile Labs
09IRS letter
Naturopath
38Copy of current license showing authority to practice as this provider type, SSN documentation
Non-Payable Provider
--
Nurse Practitioner (Advance Practice Nurse)
42Copy of current license showing authority to practice as this provider type, SSN documentation
Nursing Care Facility
81IRS letter, Medicare information
Occupational Therapist
45Copy of current license showing authority to practice as this provider type, SSN documentation
Optical Clinic
44IRS letter
Optometrist
43Copy of current license showing authority to practice as this provider type, SSN documentation
Oral Surgeon (Dental)
17Copy of current license showing authority to practice as this provider type, SSN documentation
Oral Surgeon (Medical)
34Copy of current license showing authority to practice as this provider type, SSN documentation
Oregon State Hospital
35Copy of current license showing authority to practice as this provider type, IRS letter, Medicare information
Pharmacist for Medication Therapy Management services (to bill OHA directly)
50 (specialty 106)Copy of certification, SSN documentation
Physical Therapist
45Copy of current license showing authority to practice as this provider type, SSN documentation
Physician Assistant
46Copy of current license showing authority to practice as this provider type, SSN documentation
Physicians
34Copy of current license showing authority to practice as this provider type, SSN documentation
Podiatrist
19Copy of current license showing authority to practice as this provider type, SSN documentation
Polygrapher
54SSN documentation
Portable X-ray
52IRS letter, Machine registration license, Medicare information
Psychologist (only for billing exams/reports requested by DHS/OYA)
53Copy of current license showing authority to practice as this provider type, SSN documentation
Public Health Clinic
47IRS letter, Pharmacy license (if applicable)
Registered Dietician
58Copy of current license showing authority to practice as this provider type, SSN documentation
Registered Nurse Anesthetist
37SSN documentation
RN First Assistant
57Copy of current license showing authority to practice as this provider type, SSN documentation
Rural Health Clinic (RHC)
14IRS letter, Medicare information
School Medical
62IRS letter
Speech and Hearing Therapist
45Copy of current license showing authority to practice as this provider type, SSN documentation
Speech and Language Pathologist
45Copy of current license showing authority to practice as this provider type, SSN documentation
Substance Use Disorder Counselors
03SSN documentation
Substance Use Disorder Program(employs licensed staff exclusively)
03IRS letter, List of licensed staff that includes credentials, Statement that facility will only employ licensed staff, Statement that facility will seek OHA certification before employing unlicensed staff
Substance Use Disorder Program (employs unlicensed staff)
03IRS letter
Targeted Case Management
64IRS letter
Transportation Air Ambulance
01Copy of current license showing authority to practice as this provider type, IRS letter
Transportation Broker
01IRS letter
Transportation Ground Ambulance
01Copy of current license showing authority to practice as this provider type, IRS letter
Tribal Health Center (Indian Health Service or Tribal 638)
28IRS letter

If you want to enroll with an OHP health plan:

Medical and behavioral health providers: If you have questions about enrolling with a coordinated care organization (CCO), contact the CCO. If you were denied participation in a CCO's provider network, read about the OHA Provider Discrimination Review process and form.

Dental providers: If you have questions about enrolling with an OHP dental plan, contact the plan.

Need help?

  • To get help enrolling with OHA: Call Provider Enrollment at 1-800-422-5047 or e-mail provider.enrollment@state.or.us.
  • To stay enrolled: Submit updates within 30 days of the change on the OHP 3035 form. Also send us a copy of your licensure renewal when you receive it from your licensing board. When faxing the 3035 or licensure renewals, please fax directly to Provider Enrollment at 503-947-1177 (Salem). An EDMS Coversheet is not required.
  • To request direct deposit: Submit the MSC 189 (Direct Deposit Authorization Form) to DHS/OHA Financial Services. For Medicaid EHR Incentive Program payments, enter the Oregon Medicaid provider number and account information associated with the payee you identified when registering with CMS for EHR incentive payments.

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