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  • Ohp 3302 - English. Appeal And Hearing Request Form

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ProgramAgency Use Only Branch Case NumberHealth Systems DivisionDenial of medical services Appeal and hearing request Complete pages 1 and 2 of this form. Return the form as listed on page 2. The.

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Submit the complaint in person or via mail to: Health License Office, 1430 Tandem Ave. NE, Suite 180, Salem, OR 97301, fax: (503) 370-9216, or email: hlo.info@dhsoha.state.or.us.

​You must contact your CCO within 60 days from the date on the Notice of Adverse Benefit Determination. Tell your CCO you want to appeal their decision. Follow the instructions on the notice from your CCO. Find your CCO contact information on your CCO Member ID card or visit the CCO Plans page.

You can also find the guide at OHP�Oregon�gov. Complete all required pages, then SIGN your application and send it to: Mail: OHP Customer Service, P.O. Box 14015, Salem, OR 97309-5032 Fax: Use the yellow coversheet in this packet to fax your documents to 503-378-5628.

For paper claims: Mail the CMS-1500 or UB-04 claim form to OHP, PO Box 14955, Salem OR 97309.

By email: oregonhealthplan.changes@state.or.us Existing members can email OHP to change your address, phone number, family status, CCO or other information.

(2) A claim submitted within 12 months of the date of service but is denied may be resubmitted within 18 months of the date of service. These claims must be submitted to the Health Systems Division (Division) at the address listed in the provider contacts document.

It may be up to 45 calendar days after they get your completed application. If ODHS has to make an eligibility decision based on a disability, it may take longer. If you do not receive anything after 45 days, you can ask about the status of your application.

Oregon Health Plan Email: You can send a secure email with your changes to Oregon.Benefits@dhsoha.state.or.us. Include your full name, date of birth, Oregon Health ID number, and phone number. Call: 1-800-699-9075 (toll-free) from 8 a.m.to 5 pm. Monday to Friday.

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© Copyright 1997-2025
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Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232