How to Verify Patient Eligibility, Enrollment and Service Coverage
Provider Services no longer provides eligibility or enrollment status over the phone. Please use the resources on this page for these inquiries. This maintains the privacy and security of protected health information.
Oregon Administrative Rule (OAR) 410-120-1140 requires providers to verify the patient's eligibility and benefit package. Providers must also verify the member's coordinated care organization (CCO) enrollment, whether services are covered by the Prioritized List of Health Services, and whether services require prior authorization.
View the Keys to Success to learn more.
Oregon Health Authority (OHA) offers three ways to verify this information for OHP members:
The Provider Portal allows you to view up to 13 months of historical eligibility data (through the date of inquiry). You can't request eligibility verification for future dates.
Go https://www.or-medicaid.gov. Login and click “Eligibility" to get started. To learn more:
If you can't login or become locked out of the portal, contact us:
Register with OHA or an OHA-registered clearinghouse for electronic data interchange (EDI). With EDI you can do eligibility inquiries with OHA using your office's practice management software. To learn more, visit the EDI page.
You can verify eligibility in the Provider Portal using their last name, first name and date of birth. They can also look up their ID number by logging into ONE.Oregon.gov (under "Current Benefits").
MMIS Provider Portal >>
Eligibility and Enrollment Guide >>
Prioritized List of Health Services >>