Oregon Health Plan Provider Revalidation

Background

State Medicaid agencies are federally required to revalidate the enrollment of all enrolled providers at least every 5 years (see 42 CFR §455.414). This requirement:

Applies to all providers, including rendering, billing, ordering and referring providers.
Permits state Medicaid agencies to revalidate more frequently, at their discretion.

How Revalidation Works

When it is time for revalidation, we will send enrolled health care providers a notice, using the Mail-to address listed in our system for the health care provider.

The notice applies only to the provider name and Oregon Medicaid ID listed at the top of the notice.
Failure to return requested revalidation information for the listed provider may result in the Oregon Health Authority (OHA) ending the provider's participation in Oregon's Medicaid program, as outlined in Oregon Administrative Rule 410-120-1260(16)(b) - Terminations).

What Providers Need to Do

Complete and return the form(s) listed below only for the provider listed on the notice. OHA must receive the form(s) by the due date listed on the notice.

Fax to 503-378-3074 under the EDMS Coversheet (mark the "Provider Enrollment" box).
If you cannot return the forms via fax, or faxing is unsuccessful, please email provider.revalidation@odhsoha.oregon.gov to ask about other submission options.

Provider Revalidation Forms

Only complete these forms if OHA has sent you a revalidation notice asking you to do so, or if your provider number is listed in the revalidation files below. Please email provider.revalidation@odhsoha.oregon.gov if you have any questions about: revalidation, such as which forms to complete.

Behavioral Health Personal Care Attendant providers (only): Complete the OHA 2521 and OHA 3975.

All other individual providers: Complete the OHP 3113 and OHA 3975

Complete the following forms:

Revalidation File

The files below list providers who need to submit revalidations and their revalidation status:

The date OHA received their revalidation,
Whether OHA completed their revalidation, and
The date OHA inactivated a provider's enrollment due to revalidation.

To find your status, please check the revalidation file that shows the due date in your revalidation notice from OHA.

If OHA receives revalidations after a provider's inactivation date:

OHA will process revalidations received within 30 days of inactivation as revalidations.
OHA will process revalidations received after 30 days of inactivation as re-enrollments. This may require submitting additional forms based on provider type. Providers will remain inactive until OHA processes their re-enrollment.

Documents
03/28/2023 File: Revalidations due 04/30/2023 (THW and Pharmacy)
03/28/2023 File: Revalidations due 01/31/2023 (CRNA, DME and Hospital)
02/08/2023 File: Revalidations due 08/31/2022 (Lab, Naturopath, Psychologist (53) and Transportation)
02/08/2023 File: Revalidations due 10/31/2022 (Acupuncturist, Chiropractor and Optometrist)
11/01/2022 File: Revalidations due 06/30/2022

Questions?

Email us