To Get Started:
Find out if you are already enrolled with Oregon Health Authority (OHA).
To do this, use OHA's online tool. Just enter your National Provider Identifier (NPI).
To enroll, you need to know your provider type and specialty code. Use this list to find the codes you need. To find taxonomy codes,
search the NPPES website using the provider's NPI.
Learn How to Enroll, Update Information or Revalidate
Click the boxes below to learn what you need to submit.
For individuals whose services are billed by an organization, complete the OHP 3113 and OHA 3975 forms.
- Rendering, ordering, prescribing, and referring providers must enroll using these forms.
- All providers who write prescriptions for OHP members must be enrolled with Oregon Medicaid for their prescriptions to be covered by Oregon Medicaid.
For individuals who intend to bill directly for their services, complete the OHA 3972 and OHA 3975 forms.
For behavioral health personal care attendants, complete the OHA 2471 and OHA 3975 forms.
For organizations, complete the OHA 3972, OHA 3974 and OHA 3975 forms. Only these organizations need to also fill out other forms:
- Behavior Rehabilitation Services: Counties that provide local match funding must also complete the OHP 3101 form.
- Durable Medical Equipment providers must also complete the OHP 3116 form.
- Federally Qualified Health Centers must also complete the OHP 3027 form and FQHC attachment.
- Hospitals must also complete the OHP 3111 form.
- Pharmacies must also complete the OHP 3115 form.
- Portable X-ray providers must also complete the OHP 3105 form.
- Rural Health Clinics must also complete the OHP 3027 form and RHC attachment.
- Targeted Case Management providers must also complete the OHP 3103 form.
Submit updates within 30 days of the change.
For changes in ownership or managing employees:
Complete a new OHA 3974 form.
If an NPI is changing due to change of ownership, submit all forms required for enrollment or re-enrollment. Do not submit a change of ownership for an existing enrolled provider.
For other information updates:
To update address, contact information, taxonomy or other information:
- For non-payable individual providers, submit a new OHP 3113 form.
- For behavioral health personal care attendants (provider type 30), complete the OHA 2521 form.
- For all other payable individual providers and organizations, submit a new OHA 3972 form.
We do not need this information for people licensed by the Oregon Medical Board, Oregon Board of Pharmacy, or Oregon Board of Nursing. This is true even if you get a letter asking you to send it to us.
For all other licensed practitioners, fax a copy of the renewed license along with a copy of the license notice received to 503-947-1177 (Salem).
How to Submit Forms to OHA
Use only the forms posted below. OHA only accepts previous versions of posted forms for three months after the revision date. For example, if a form is revised in January, OHA will only accept the older version through April.
Use the online request. Before using, review the step-by-step guide.
View the step-by-step guide >>
Go to the online request >>
Do not use the online request for license updates. See the license renewals section of this page for information on how to submit license updates.
All forms are fillable PDFs. If you use Mozilla Firefox, you may need to change your download settings to see the fillable version.
Complete all required forms and save them to your computer or network drive. Make sure each completed form:
- Is a PDF, TIFF or TXT file;
- Is a file size of 10 MB or less; and
- Has a file name that is 256 characters or less.
Fax your application to 503-378-3074. OHA can only accept requests that are under an EDMS coversheet with the “Provider Enrollment" box marked at the top of the coversheet.
- To find the coversheet, search for “EDMS" in the forms search below.
- On the EDMS coversheet, check the "Provider Enrollment" box at the top of the form.
If you fax without an EDMS coversheet, or the “Provider Enrollment" box is unchecked on the coversheet, Provider Enrollment will not receive those requests. To ensure receipt of faxed requests, contact Provider Enrollment at least 48 hours after faxing.
Other Requirements
Coordinated care organizations (CCOs) are the Medicaid managed care plans that serve over 90 percent of Oregon Health Plan members.
All providers subject to NPI requirements must have a 10-digit NPI. (Providers not subject to NPI, such as transportation providers, are not required to provide an NPI). OHA cannot enroll new providers without this number.
- To get an NPI, apply online at the National Plan and Provider Enumeration System (NPPES) website.
- To look up your NPI information, use the NPI Registry.
Until further notice, please use the MSC 189 (EFT Enrollment Form for Providers, Vendors, and Contractors) to update your electronic funds transfer (EFT/direct deposit) account information.
OHA has deactivated the EFT Account update feature in the Demographic Maintenance panel of the MMIS Provider Portal in order to determine additional security features needed for EFT updates in the Portal.
Sanctioned Providers
OHA has prohibited the following providers from serving OHP members. You can also
search the OHA Medicaid Program Integrity Audit Unit's list of State Medicaid Fraud Convictions.