Oregon Health Plan (OHP) Provider Enrollment

Before Getting 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, search for “Non-Payable Provider." This includes rendering, ordering, prescribing, and referring providers.

All providers who write prescriptions for OHP members must be enrolled with Oregon Medicaid for their prescriptions to be covered by Oregon Medicaid.
To learn more about this requirement, read OHA's Prescriber Enrollment Questions and Answers.

For individuals who intend to bill directly for their services, search for “Payable Individual."

For organizations, search for your provider type or provider type number as shown on the Enrollable Provider Types and Specialties list.

Submit updates within 30 days of the change.

For changes in ownership or managing employees:

Search for “Ownership."

If an NPI is changing due to change of ownership, a submit a new enrollment application. Do not submit a change of ownership for an existing enrolled provider.

For other information updates:

Search for “Provider update" to update address, contact information, taxonomy or other information.

See the instructions on OHA's Provider Revalidation page.

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).

Fee-for Service (FFS) Enrollment Forms and How to Submit

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.

For CCO Enrollment:

CCOs are the plans that serve OHP members. Contact the CCO for questions about CCO enrollment and credentialing.

To Verify FFS Enrollment:

View the file below. This file:

Lists active FFS providers as of the date listed on the file.
Does not include providers who serve CCO members only.

The group affiliation field is informational only. Group affiliation does not affect claim processing.

To Check Status of Your FFS Application:

Check enrollment status online using the Application Tracking Number (ATN) on your application.

OHA Fax Numbers

503-378-3074 for enrollment forms, updates and revalidations

503-947-1177 for licensure renewals and CLIA updates. An EDMS Coversheet is not required.

Related Rules

410-120-1260 - Provider Enrollment

410-120-1400 - Provider Sanctions

410-120-1460 - Type and Condition of Sanctions

Questions?

If you need help with FFS enrollment or updates, please email us or call 800-336-6016 (option 6).

Other Requirements

Coordinated care organizations (CCOs) are the Medicaid managed care plans that serve over 90 percent of Oregon Health Plan members.

If you have questions about enrolling with a (CCO) or one of the CCO's dental networks, contact the CCO.
If you were denied participation in a CCO's provider network, read the OHA Provider Discrimination Review form and process.

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

To find out about providers who have been prohibited from serving Oregon Medicaid clients, search the list below. You can also search the OHA Medicaid Program Integrity Audit Unit's list of State Medicaid Fraud Convictions.

Oregon Health Plan (OHP) Provider Enrollment

Before Getting Started:

Learn How to Enroll, Update Information or Revalidate

For fee-for-service enrollment or re-enrollment:

For changes:

For changes in ownership or managing employees:

For other information updates:

For revalidations:

For licensure renewals:

Fee-for Service (FFS) Enrollment Forms and How to Submit

How to complete and save forms:

If you cannot use the online request: