How to Verify OHP Eligibility and CCO Enrollment
OHA offers three ways for enrolled Oregon Medicaid providers to access eligibility and enrollment 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.
Register for Electronic Data Interchange (EDI) with OHA or an OHA-registered clearinghouse and do batch submissions of eligibility inquiries for OHA 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.