Check only one box and fax to the number shown. Use a new coversheet for each transaction. Provider Enrollment (PE) - 503-378-3074 Claim Documentation - 503-378-3086 Prior Authorization (PA) For PA requests, also check one box below: Routine Processing - 503-378-5814 Urgent Processing (72 hours) 503-378-3435 Immediate Processing (24 hours) Hearing Documentation (no central fax #) Grievance Documentation (no central fax #) Correspondence - 503-378-3086 Justification and additional documentat.
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How to use or fill out the OR OHP 3113 online
The OR OHP 3113 is a crucial form for enrolling providers with Oregon Medicaid for non-reimbursement purposes. This guide will walk you through the steps needed to successfully fill out the form online, ensuring a smooth submission process.
Follow the steps to complete the OR OHP 3113 form online.
- Select the ‘Get Form’ button to access the OR OHP 3113 form and open it in your preferred editor.
- Complete the individual provider information section. Provide required details such as last name, first name, middle initial, date of birth, and social security number.
- Fill in the necessary licensing details, including the license/certification number and the respective licensing board.
- If applicable, enter the Medicare ID and corresponding effective and expiration dates for your license or certification.
- Complete the address information section, ensuring you provide a physical location where services will be rendered.
- Provide the Medicaid enrollment information, including the out-of-state Medicaid provider ID if you are not an Oregon provider.
- Enter the relevant provider types and taxonomy codes based on your enrollment needs.
- Fill out the group affiliation information if you are associated with a group, clinic, or agency.
- Indicate the effective date for the enrollment request, ensuring it is not older than one year from the submission date.
- Sign the form, certifying that all provided information is true and complete. Ensure to print your name and date of signing.
- Once completed, you can save the form, download it, print it, or share it as required.
Complete your OR OHP 3113 form online today for efficient processing.
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Get answers to your most pressing questions about US Legal Forms API.
Is CareOregon the same as Medicaid?
For more than 25 years, CareOregon has served Oregonians who qualify for Medicaid by providing health insurance and much more. We believe that by making individuals and families healthier, we make entire communities healthier too.
Is OHP the same as Oregon Medicaid?
The Oregon Health Plan (OHP) is Oregon's Medicaid program. There are several health care programs available for low-income Oregonians through OHP.
What is another name for Oregon Health Plan?
Oregon Health Authority : Oregon Health Plan (OHP) Benefits : Oregon Health Plan : State of Oregon. If you or someone you know is struggling or in crisis, help is available.
What is the phone number for OHP authorization?
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.
Is Oregon Health Plan the same as Affordable Care Act?
Effective January 2014, the OHP Standard package was transitioned into OHP Plus as part of the state's implementation of the federal Patient Protection and Affordable Care Act.
Is OHP the same as CareOregon?
Every day, CareOregon helps more than 500,000 Oregonians access free physical, dental, mental health care and prescription drug coverage through the Oregon Health Plan (OHP). Enter our Members section to find out if you're eligible, search for providers, learn about CareOregon benefits, and more.
How do I find my Oregon Health Plan provider?
Call OHP Care Coordination at 800-562-4620. Find providers online using the online provider search. You can search by provider type and specialty.
What is the Oregon Health Plan Oregon's version of?
The Oregon Health Plan (OHP) is Oregon's Medicaid program. There are several health care programs available for low-income Oregonians through OHP.
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