Oregon Health Authority Requirements
Click the boxes below to learn what you need to submit to the Oregon Health Authority (OHA) to enroll as an Oregon Health Plan provider, update your information, or maintain your current enrollment.
Read OHA's new Provider Enrollment guide to learn how to enroll and submit required documents online.
To bill OHA directly, find your provider description in the list below. Complete and fax all forms and documentation listed for your description.
For rendering, ordering, prescribing and referring providers, use "Non-Payable Provider" as the search term.
- All providers who write prescriptions for Oregon Health Plan members must be enrolled with Oregon Medicaid in order for their prescriptions to be covered by Oregon Medicaid.
- To learn more about this requirement, read OHA's Prescriber Enrollment Questions and Answers.
Submit updates within 30 days of the change under the EDMS Coversheet.
- For changes in ownership, search for "Ownership change only."
- For other information updates, such as address, contact information, or taxonomy information, search for "Provider update."
Fax your new license directly to Provider Enrollment at 503-947-1177 (Salem). Please include a copy of the licensure notice, Medicaid ID or NPI for the provider. An EDMS Coversheet is not required.
If you are licensed by the Oregon Board of Medical Examiners, the Oregon Board of Pharmacy, or the Oregon Board of Nursing, you do not need to send us this information. This is true even if you get a letter asking you to send it to us.
OHA enrollment and updates:
Call Provider Enrollment at 800-336-6016 (option 6) or email firstname.lastname@example.org.
Requesting direct deposit:
Until further notice, please use the MSC 189 (EFT Enrollment Form for Providers, Vendors, and Contractors) to update your EFT account information.
OHA has deactivated the EFT Account update feature in the Demographic Maintenance panel of the MMIS Provider Portal in order to determine additional security features needed for EFT updates in the Portal.
OHA Enrollment Forms
All forms are fillable PDFs. Please fill out electronically. If you use Mozilla Firefox, you may need to change your download settings to see the fillable version.
To be sure you are using the most current versions of OHA’s enrollment forms, please use only the forms posted below. OHA only accepts previous versions of posted forms for three months after the revision date. For example, if a form is revised in April, OHA will only accept the older version through June.
Coordinated care organizations (CCOs) are the Medicaid managed care plans that serve over 90 percent of Oregon Health Plan members.
All providers subject to NPI requirements must have a 10-digit NPI. (Providers not subject to NPI, such as transportation providers, are not required to provide an NPI). OHA cannot enroll new providers without this number.
- 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.
To find out about providers who have been prohibited from serving Oregon Medicaid clients, search the list below. You can also search the OHA Medicaid Program Integrity Audit Unit's list of State Medicaid Fraud Convictions.