Oregon Health Plan Provider Revalidation

Background

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(16)(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.

• Submit online. Read OHA's Provider Enrollment Guide to learn more.
  
• Fax to 503-378-3074 under the EDMS Coversheet (mark the "Provider Enrollment" box).
• If you cannot return the forms online or via fax, please email provider.revalidation@odhsoha.oregon.gov to ask about other submission options.

Provider Revalidation Forms

Only complete these forms if OHA has sent you a revalidation notice asking you to do so, or if your provider number is listed in the revalidation files below. Please email provider.revalidation@odhsoha.oregon.gov if you have any questions about: revalidation, such as which forms to complete. 

Revalidation File

The files below list providers who need to submit revalidations and their revalidation status:

• The date OHA received their revalidation,
• Whether OHA completed their revalidation, and
• The date OHA inactivated a provider's enrollment due to revalidation. 

To find your status, please check the revalidation file that shows the due date in your revalidation notice from OHA.

If OHA receives revalidations after a provider's inactivation date:

• OHA will process revalidations received within 30 days of inactivation as revalidations.
  
• OHA will process revalidations received after 30 days of inactivation as re-enrollments. This may require submitting additional forms based on provider type. Providers will remain inactive until OHA processes their re-enrollment.