The requesting, performing and referring providers for the requested service(s) must all be enrolled Oregon Health Plan (OHP) providers.
How to submit prior authorization 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, use the Provider Web Portal or MSC 3971 (updated March 2018). 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.
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 Web 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