Health Authority Forms and Office Locations – Government Agency in Oregon

121 - 140 of 156 forms

Form Title	Topics
Per Member Per Month (PMPM) Patient Reporting Template - For Alternate Payment Methodology (APM) payments
Physical Residual Function Capacity Report
Positioner Justification - Positioners for Standing
Pregnancy Notification
Prior Authorization for Out-of-State Services
Prior Authorization Request for Pharmacy and Oral Nutritional Supplements
Private Duty Nursing Acuity Grid
Private Duty Nursing Psychosocial Grid
Provider Information Update
Provider Web Portal Quick Setup Guide
Psychiatric/Psychological Evaluation
Request for Claim or Service Authorization Review (formerly Request for Administrative Review
Request for Transplant or Transplant Evaluation
Request to End Medicare Advantage and Medicare Special Needs Plan Enrollment
Sample OHP Coverage Letter and inserts - View the information you will receive when you are new to OHP, have changes to your OHP coverage, or request a new ID card
Submit if you only need to enroll with OHA for non-billing purposes (e.g., as a rendering, ordering, prescribing, referring provider; or for Provider Web Portal access)
Substance Use Disorder Residential Treatment Facility Admission/Discharge Notification
The Oregon Health Plan - It May Be for You
The Oregon Health Plan - It May Be For You (Russian
The Oregon Health Plan - It May Be For You (Spanish

Health Authority