Skip to main content
Oregon.gov Homepage

How to submit prior authorization requests to OHA

Provider requirements

The requesting, performing and referring providers for the requested service(s) must all be enrolled Oregon Health Plan (OHP) providers.

How to submit prior authorization requests

  • For services covered by the patient's coordinated care organization (CCO), refer to the CCO for their procedures.
  • For services covered fee-for-service by the Oregon Health Authority, use the Provider Web Portal or MSC 3971 (updated March 2018). The Prior Authorization Handbook provides step-by-step instructions.

Also check the Prioritized List of Health Services to see if OHP will cover the requested service for the condition being treated.

Please attach only the clinical documentation required for review. Do not attach unrelated documents.

  • Sending more than the required documents to determine medical necessity may delay review.
  • For specific requirements, refer to the program rules and provider guides for the requested service(s).

How to submit updates for existing requests

  • Use the Provider Web Portal (search by Prior Authorization Number for the existing request), or
  • Fax a new MSC 3971 with requested documentation. List the Prior Authorization Number for the existing request on the EDMS Coversheet; otherwise, the request will be processed as a new request, delaying review.

How to check prior authorization status

OHA no longer calls providers with prior authorization status. To find out the status of a prior authorization request submitted to OHA:

Fee-for-service prior authorization resources

Tools

  
  
  
  
  
  
  
  
  
  
  
  
  
  
  
  

 

Forms and quick references

Description
  
DHS|OHA Prior Authorization Request
MSC 3971
Prior Authorization for Out-of-State Services​
OHP 1074
Augmentative Communication Device Selection Summary Report​
OHP 3047
Request for Transplant or Transplant Evaluation
OHP 3084

Request for Claim or Service Authorization Review (formerly Request for Administrative Review)

OHP 3085
Positioner Justification - Positioners for Standing​​
OHP 3155

How to use the Provider Web Portal Benefits and Prioritized List Inquiry screen​

OHP 3163
Prior Authorization Request for Pharmacy and Oral Nutritional Supplements
OHP 3978
Private Duty Nursing Psychosocial Grid​
OHP 590
Private Duty Nursing Acuity Grid​
OHP 591

Quick links

Prioritized List of Health Services

Program rules and provider guides

Webinar: Fee-for-service physical health prior authorizations

Questions? Call
800-336-6016

  • For prior authorization status: Choose option 3
  • For clinical questions: Choose option 4

Your browser is out-of-date! It has known security flaws and may not display all features of this and other websites. Learn how

×