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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(15)(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.

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

Personal Care Attendant providers: Complete the OHA 2521​ and OHA 3975​.

All other individual providers: Complete the OHP 3113.​​

Complete the following forms:


Complete the following forms:

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