Oregon Health Plan provider revalidation

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@dhsoha.state.or.us 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. If you have questions about which forms to complete, please email provider.revalidation@dhsoha.state.or.us.

Individuals:

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

Organizations:

Complete the following forms:

Payable Individuals (providers who bill OHA directly)

Complete the following forms:

Revalidation file

The file below lists providers who need to submit revalidations, and providers whose enrollment was inactivated due to revalidation.

The filename lists the date of the current file and the revalidation due date for listed providers.
OHA will only process revalidations for inactivated providers if received within 30 days of inactivation.

Documents
05/20/2022 File: Revalidations due 06/30/2022