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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.

Before Submitting 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, 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.

Also see whether the service(s) require authorization. Refer to the provider guidelines for your program, or use the HSC List Inquiry in the Oregon Medicaid Provider Portal at

What to Submit with Initial Requests to OHA

Use the Provider Portal or MSC 3971 (updated March 2018).

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 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


Electrolysis and laser hair removal authorization requirements
Fee-for-service review of unfunded or comorbid physical health services
FFS Orthodontia Review Criteria
How to submit physical health prior authorization requests
Join OHA's no-cost EPSDT provider education session Feb. 15, 2023
Oregon Medicaid long-term acute care prior authorization criteria
Planned Community Birth Prior Authorization and Billing Guide
Prior Authorization Handbook
Provider Tips - Claim and PA Issues
Provider Tips - EDMS Coversheet
Questions and answers about prepayment review of outpatient occupational, physical and speech therapy claims
Questions and answers from the "Ensuring EPSDT Access" webinar
Questions and answers from the "EPSDT Program Overview" webinar
Requesting medical review of CCO disenrollment requests
Requirements for fee-for-service outpatient physical, occupational and speech therapy claims
Submit and check status of prior authorization requests

Forms and quick references

MSC 3970
EDMS Cover Sheet​
MSC 3971
ODHS|OHA Prior Authorization Request
OHP 1074
Prior Authorization for Out-of-State Services​
OHP 3047
Augmentative Communication Device Selection Summary Report​
OHP 3084
Request for Transplant or Transplant Evaluation
OHP 3085

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

OHP 3155
Positioner Justification - Positioners for Standing​​
OHP 3163

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

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


Physical health requests

Behavioral health requests

Applied behavior analysis request forms 

IQA website and request forms: For State Plan Personal Care and 1915(i) services


Forms, contact information and fee-for-service PA criteria on the Pharmaceutical Services policy page.


Prioritized List of Health Services

Program Rules and Provider Guides

Fee-for-service physical health requests


Call 800-336-6016.

  • For help with existing prior authorization/requests: Choose option 3
  • To find out if a specific diagnosis/procedure code pair requires authorization: Choose option 4