How to become an Oregon Health Plan provider

NOTE: Effective Sept. 1, 2008, DMAP will only accept provider enrollment forms currently available on this Web site. DMAP will return older versions of these forms for resubmission on the current forms.

• Step 1: Complete, print and sign all enrollment forms
• Step 2: Mail completed forms and required documentation to DMAP
• Step 3: Sign up for direct deposit and Electronic Data Interchange
• Step 4: Keep your information updated

If you have questions, call DMAP Provider Enrollment at 800-422-5047 or e-mail provider.enrollment@state.or.us.

Step 1: Complete, print and sign all enrollment forms

• Print and use this checklist to make sure you complete everything you need to get started as an OHP provider.
• Then click here to find all the enrollment forms you need to complete for your provider type. All forms can be completed on your computer using Microsoft Word or Adobe Reader.
• If you are a mental health or chemical dependency provider, also refer to the AMH Provider Manual for information on AMH’s enrollment requirements.

Step 2: Mail completed forms and required documentation to DMAP

• DMAP only accepts enrollment applications by mail. Any forms that require a signature must be originals (not copies).
• Make sure to submit all documentation requested on these forms. If you do not mail in all required documentation, your enrollment may be delayed until you submit the required documentation.
• Mail your completed enrollment forms, with all required documentation and original signatures, to:

Step 3: Sign up for direct deposit and Electronic Data Interchange

• If you want to receive DHS payments electronically, send a completed and signed Direct Deposit Authorization Form (DMAP 3077) as indicated on the application form.
• If you want to do business with DHS using Electronic Data Interchange (EDI), complete and sign the EDI Registration Packet (DHS 2080 Packet) - This packet includes the Trading Partner Agreement (DHS 2080), Exhibit A (DHS 2081) and Exhibit B (DHS 2082). For more information about EDI registration, go to the EDI Testing and Registration page.
• Also make sure to register your National Provider Identifier and associated taxonomy codes using the DMAP 1038 (NPI Registration Form). For more information about NPI, review the DHS NPI Tutorial (in PowerPoint or PDF).

Step 4: Keep your information updated

If you need to update the information on your Provider Enrollment form, use the Provider Information Update, DMAP 3035 (PDF). Submit any updates within 30 calendar days of the change.

DMAP General Rule 410-120-1260(10) (Provider Enrollment Required Updates) states that enrolled providers must report changes to address, business affiliation, licensure, certification, ID numbers (including billing ID, NPI, or Federal Tax ID), ownership and control information, or any other information that relates to the provider’s qualification to provide services as a Medicaid provider.