How to Submit Prior Authorization Requests to OHA

Provider Requirements

• Use our enrollment verification tool to verify OHP enrollment using the provider's National Provider Identifier.
• For providers not enrolled with OHP, complete and submit the OHP 3113 form to OHP Provider Enrollment.

Before Submitting 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, 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.

Also see whether the service(s) require authorization. Refer to the provider guidelines for your program, or use the HSC List Inquiry in the Oregon Medicaid Provider Portal at https://www.or-medicaid.gov.

What to Submit with Initial Requests to OHA

Use the Provider Portal or MSC 3971 (updated March 2018).

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 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:

• Use the Provider Portal “PA Inquiry” function. To learn more about checking status on the web, view our self-study guide.  Don’t have a Provider Portal account? Learn how to get one on the Provider Portal resources page.
• Review the notices OHA sends you. Sample notices are in the Prior Authorization Handbook. If you don’t get notices from OHA, you may need to update your mailing address. To learn how to update your mailing address with OHA, visit the Provider Enrollment page. 

Fee-for-Service Prior Authorization Resources