OHA 3113OHA 3975 FFS Non-Payable Provider Enrollment Form-2025

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The document is an EDMS Coversheet used for faxing documents to the Oregon Medicaid Electronic Document Management System. It outlines the process for submitting various types of requests, including Provider Enrollment, Claim Documentation, and Prior Authorization, along with specific fax numbers for each type. The document also includes instructions for completing the Non-Payable Provider Enrollment Form, which is required for enrolling or updating provider information with Oregon Medicaid. Additionally, it emphasizes confidentiality and provides contact information for further assistance.

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Versions	Form popularity	Fillable & printable
2024	4.6 Satisfied (34 Votes)
2019	4.2 Satisfied (52 Votes)
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Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

How do I check my Medicaid status in Oregon?

Verify member eligibility, benefits and enrollment at At the main menu, click Eligibility. Enter the members Oregon Health ID number or Social Security number, plus name or date of birth, then click search.

How do I contact Oregon Medicaid provider enrollment?

Be sure to review the self-service tools and resources on the website, including the OHP Provider Contacts list, to make sure you get in touch with the specific people who can help. If you still need help, call Provider Services at 800-336-6016.

What does provider mean on an insurance form?

Providers can include doctors, psychologists, or physical therapists, and health care facilities, like hospitals, urgent care clinics, or pharmacies. Insurance companies may have different networks for different plans, so make sure you search the provider network of each specific plan you compare.

What is a provider enrollment application?

In the most basic terms, provider enrollment (sometimes referred to as payer enrollment) is the process through which healthcare providers apply to be included in a health insurance network. As an in-network provider, you will be able to treat patients who carry that insurance and be reimbursed for your services.

Why is provider enrollment important?

Why Is Provider Enrollment Important? Provider enrollment allows providers to join the insurance plans accepted by their healthcare organization or practice. Its also a legal requirement. Most insurance companies and government payers, like Medicare, require providers to be enrolled before they can submit claims.

What is the purpose of a health enrollment form?

Enrollment forms record whether employees have enrolled in or waived group benefits. For instance, if you have more than 50 full-time employees, you will need this data to complete IRS forms 1094 and 1095, which record health care coverage.

How to get an NPI number in Oregon?

To get an NPI, apply online at the National Plan and Provider Enumeration System (NPPES) website. To look up your NPI information, use the NPI Registry.

OHA 3113OHA 3975 FFS Non-Payable Provider Enrollment Form-2025

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