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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.
To bill OHA directly, find your provider description in the list below. Complete and fax all forms and documentation listed for your description.
Submit updates within 30 days of the change under the EDMS Coversheet.
Fax your new license directly to Provider Enrollment at 503-947-1177 (Salem). An EDMS Coversheet is not required.
See the instructions on OHA's Provider Revalidation page.
Call Provider Enrollment at 800-336-6016 (option 6) or email firstname.lastname@example.org.
Once you are enrolled and have created your MMIS Provider Web Portal account, login and go to Providers>Demographic Maintenance.
All forms are fillable PDFs. Please fill out electronically. Handwriting is required for signature fields only. If you use Mozilla Firefox, you may need to change your download settings to see the fillable version.
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 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.
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