Handling paperwork with our feature-rich and intuitive PDF editor is easy. Make the steps below to complete Medicaid Provider Enrollment Application and Agreement online quickly and easily:
Take advantage of DocHub, the most straightforward editor to promptly manage your paperwork online!
This form is essential for various stakeholders including individual healthcare providers, organizations, clinics, and businesses seeking to enroll in the Oregon Medicaid program. For instance, sole proprietors who wish to bill directly using their National Provider Identifier (NPI) must complete this application. Additionally, organizations such as non-profits or LLCs that provide medical services are required to submit this form to receive reimbursement for their services. It is also applicable for re-enrollment or updates when there are changes in provider information.
Providers must ensure that all sections of the form are completed accurately to avoid delays in processing. The application should be submitted within specific timeframes; for example, new providers should apply before rendering services to ensure timely reimbursement. Documentation such as proof of licensure and tax identification numbers must accompany the application.
To submit the Medicaid Provider Enrollment Application, first obtain the latest version of the OHA 3972 form from the Oregon Health Authority's website. After filling out all necessary information and attaching required documentation, you can either fax your completed application or submit it online through their designated portal.
It is vital for applicants to be aware that outdated forms will not be accepted, which emphasizes the importance of using current versions available on official websites. Furthermore, any inaccuracies or omissions may lead to significant delays in processing applications or even denial of enrollment.
