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Oregon Health Plan Provider Enrollment

Enroll, Update Information or Revalidate Online

Use the online Provider Enrollment application to submit forms to Oregon Health Authority (OHA) for:

  • New enrollments,
  • Re-enrollments,
  • Provider information updates, and
  • Revalidations.

This application is not for submitting license updates.

Read the step-by-step guide to using the online application >>

Go to the online application >>

Before Getting Started:

Complete all required forms and save them to your computer or network drive. You will upload the completed forms at the end of your application. 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.

Click the boxes below to learn what you need to submit.

​To bill OHA directly, find your provider description in the list below. Complete and fax all forms and documentation listed for your description. 

For rendering, ordering, prescribing and referring providers, use "Non-Payable Provider" as the search term.
  • All providers who write prescriptions for Oregon Health Plan members must be enrolled with Oregon Medicaid in order for their prescriptions to be covered by Oregon Medicaid.
  • To learn more about this requirement, read OHA's Prescriber Enrollment Questions and Answers.
To find out if you are already enrolled with OHA, use OHA’s verification tool. Just enter your NPI. 

​Submit updates within 30 days of the change under the EDMS Coversheet.

  • For changes in ownership, search for "Ownership change only."
  • For other information updates, such as address, contact information, or taxonomy information, search for "Provider update."

​See the instructions on OHA's Provider Revalidation page.

​OHA enrollment and updates:

Call Provider Enrollment at 800-336-6016 (option 6) or email provider.enrollment@odhsoha.oregon.gov​.    

Requesting direct deposit:

Until further notice, please use the MSC 189 (EFT Enrollment Form for Providers, Vendors, and Contractors) to update your EFT 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. ​

Provider Types and Specialties

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 National Provider Identifier (NPI). 

For CCO Enrollment:

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

To Check Enrollment Status:

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. For licensure renewals:

  • Include a copy of the licensure notice and the provider's& Medicaid ID or NPI.
  • If you are licensed by the Oregon Board of Medical Examiners, the Oregon Board of Pharmacy, or the Oregon Board of Nursing, you do not need to send us this information. This is true even if you get a letter asking you to send it to us.

Related Rules

410-120-1260 - Provider Enrollment

410-120-1400 - Provider Sanctions

410-120-1460 - Type and Condition of Sanctions

Questions?

Email us or call 800-336-6016.

OHA Enrollment Forms

All forms are fillable PDFs. Search by provider type or description for the forms to complete. To search by form number, enter the number only.

  • Please fill out electronically. If you use Mozilla Firefox, you may need to change your download settings to see the fillable version.
  • Use only the forms posted below. OHA only accepts previous versions of posted forms for four months after the revision date. For example, if a form is revised in January, OHA will only accept the older version through April.

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.

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.