OHP eligibility verification
Learn how to find out an OHP client's eligibility for health care benefits.
The General Rules provider guidelines include the Oregon Administrative Rule (OAR) that requires providers to verify eligibility before providing service.
Remember that coverage of a specific service also depends on its ranking on the Prioritized List of Health Services for the condition being treated. See the Oregon Health Plan rules, OHP Prioritized List page and Benefits and HSC List Inquiry Quick Reference to learn more.
To learn more about verifying eligibility and enrollment for Health Share of Oregon members, visit the Health Share of Oregon website.
Automated Voice Response reads back codes for a client's third-party liability (TPL) carriers, OHP managed care plan(s), and DHS/OHA benefit plans. Use these resources to find out what the codes mean:
- Insurance Carrier Codes - Provides the name and contact information for each carrier code.
- OHP Health Plan Codes - Provides the county and plan name for each code.
- Benefit Plan Codes - Provides benefit description for all benefit plan codes. Codes that indicate medical eligibility (e.g., OHP Plus) are at the top of the list.
Lost your PIN letter? Need your PIN reset? Call Provider Services at 800-336-6016. Provider Services can reset your PIN for the AVR or Provider Web Portal over the phone during regular business hours.