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Oregon Health Plan provider enrollment

National Provider Identifier (NPI) requirements

All Oregon Health Plan 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.) The Oregon Health Authority (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.
     

OHA requirements

For initial enrollment

To bill OHA directly, find your provider description in the list below.

  • Complete and fax all forms and documentation listed for your description. 
  • If you are an out of state provider (more than 75 miles outside the Oregon border) seeking payment for services to OHP members, also include the claim you are seeking payment for.

For rendering, ordering, prescribing and referring providers, use "Non-Payable Provider" as the search term.

  • Next year, any provider who writes a prescription for an Oregon Health Plan member 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.

To find out if you are already enrolled with OHA, use OHA’s verification tool. Just enter your NPI. 

For changes

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."

For licensure renewal

Fax your new license directly to Provider Enrollment at 503-947-1177 (Salem). An EDMS Coversheet is not required.

All forms are in PDF.

OHP health plan requirements 

Need help?

  • OHA enrollment and updates: Call Provider Enrollment at 800-336-6016 (option 6) or email provider.enrollment@dhsoha.state.or.us
  • Requesting direct deposit: Submit the MSC 189 (Direct Deposit Authorization Form) to DHS/OHA Financial Services. For Medicaid EHR Incentive Program payments, enter the Oregon Medicaid provider number and account information associated with the payee you identified when registering with CMS for EHR incentive payments.

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