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  • Msc 3971. Dhs/oha Prior Authorization Request

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PrintClear FormEDMS COVERSHEET Use to fax documents for entry into the Oregon Medicaid Electronic Document Management System (EDMS). Date:From:No. of Pages: (including this coversheet)Phone:Document.

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Contact support

If you still need help, call Provider Services at 800-336-6016.

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

The fastest way to apply is online. You can also fill out a paper application or call us at 1-800-699-9075 to get assistance in filling out the application in a different way.

Questions? Call Provider Services at 800-336-6016 (option 5) or visit the OHP provider website at bit.ly/ohpproviders.

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 Client Services at 800-273-0557 (TTY 711) if you: Want to change your CCO or enroll in one. Need a new Oregon Health ID card or client handbook.

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.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
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