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  • Oregon Dmap 729 Form

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State of Oregon Department of Human Services Division of Medical Assistance Programs Print Clear Form DRAFT Patient's Name SSN Insured's ID (Prime No) Date of Birth Rating of Impairment Severity Report.

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Related content

Oregon Health Authority : OHP Forms and...
Overview. This page lists forms and publications for Oregon Health Plan (OHP) applicants...
Learn more
OHSU Health Services for Providers and Clinics |...
If the patient is an Oregon Health Plan member on the date of service, the agency will...
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Contact support

Do you have questions about the Oregon Health Plan (OHP)? If you have questions about your OHP benefits, welcome packet or ID cards, please contact the Client Services Unit at 1-800-273-0557. If you have questions about eligibility, applications or related issues, please contact OHP Customer Service at 1-800-699-9075.

Call OHP Care Coordination at 800-562-4620. Find providers online using the online provider search. You can search by provider type and specialty.

Verify member eligibility, benefits and enrollment at https://.or-medicaid.gov At the main menu, click Eligibility. Enter the member's Oregon Health ID number or Social Security number, plus name or date of birth, then click “search.”

All DMAP Administrative Rules, guidelines and applications to become an enrolled DMAP provider can be found on the DMAP Web site at .oregon.gov/OHA/healthplan. For billing questions, call DMAP Provider Services toll-free at 800-336-6016 or send an e-mail to DMAP.ProviderServices@state.or.us.

Division of Medical Assistance Programs (DMAP) -- The division of the Oregon Health Authority responsible for coordinating medical assistance programs.

Call 800-336-6016.

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

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
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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