The requesting, performing and referring providers for the requested service(s) must
all be enrolled Oregon Health Plan (OHP) providers.
Before Submitting Requests:
- For services covered by the patient's coordinated care organization (CCO), refer to the CCO for their procedures.
- For services covered fee-for-service by the Oregon Health Authority, the
Prior Authorization Handbook provides step-by-step instructions.
Also check the
Prioritized List of Health Services to see if OHP will cover the requested service for the condition being treated.
Also see whether the service(s) require authorization. Refer to the provider guidelines for your program, or use the HSC List Inquiry in the Oregon Medicaid Provider Portal at https://www.or-medicaid.gov.
What to Submit with Initial Requests to OHA
Use the Provider Portal or MSC 3971 (updated March 2018).
Please attach only the clinical documentation required for review. Do not attach unrelated documents.
- Sending more than the required documents to determine medical necessity may delay review.
- For specific requirements, refer to the
program rules and provider guides for the requested service(s).
How to Submit Updates for Existing Requests
- Use the
Provider Portal (search by Prior Authorization Number for the existing request), or
- Fax a new
MSC 3971 with requested documentation. List the Prior Authorization Number for the existing request on the EDMS Coversheet; otherwise, the request will be processed as a new request, delaying review.
How to Check Prior Authorization Status
OHA no longer calls providers with prior authorization status. To find out the status of a prior authorization request submitted to OHA:
Fee-for-Service Prior Authorization Resources