Eligibility verification

This page contains information on how Oregon Health Plan (OHP) providers can verify eligibility for OHP clients. The General Rules provider guidelines include the Oregon Administrative Rule (OAR) that requires providers to verify eligibility before providing service.

New! View the new eligibility verification tutorial (PowerPoint or PDF) for quick and easy reading about how the new Medical ID and how to use the new eligibility verification options.

• Provider Web Portal
• Automated Voice Response
• 270/271 transaction
• Copayment, benefit package, other carrier information

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Provider Web Portal

The Provider Web Portal will provide free, real-time eligibility verification over the Web. It will be available 24 hours a day, 7 days a week, excepting regularly scheduled down time on the weekend.

• Web Portal Resources: This page provides instructions and quick references for logging in and using the Provider Web Portal.
• Provider Web Portal: Once you log in using your unique username and password, just click on "Eligibility" at the top of the page to access the Web eligibility screen. The Web portal will be available for login on Dec. 9. To get started on the Web portal, read the Quick Setup Guide (PDF) and how to read the Web portal eligibility screen (PDF).

Automated Voice Response

Automated Voice Response (AVR) is the free phone-based eligibility verification tool. The phone number is 866-692-3864 (toll-free).

• AVR Quick Reference (PDF): This one-page document gives an overview of the information available through AVR.
• AVR Guide (PDF): This guide provides step-by-step instructions on how to verify client eligibility and enrollment information through the AVR.
• Lost your PIN letter? Need your PIN reset? Call Provider Services at 800-336-6016. Provider Services can reset your PIN for the AVR over the phone during regular business hours.

270/271 Transaction

If you register for Electronic Data Interchange, you can do batch submissions of eligibility inquiries for DHS to verify within 24 hours using the 270/271 transaction.

• At go-live, the 271 response will not contain benefit package, copayment, or plan-specific enrollment information. If a client has any third-party resources (TPR), the 271 will indicate that TPR exists, but not what the specific resources are.
• You will need to make sure that you obtain these pieces of information through the Web portal or AVR.

To exchange the 270/271 transaction:

• Existing EDI Trading Partners can complete and submit the EDI Registration Change Request form (Word or PDF) to DHS EDI Support Services to add the 270/271 transaction to their list of registered transactions.
• New Trading Partners can complete the EDI Registration Packet and submit it to DHS EDI Support Services today.
• You may already do business through a clearinghouse that can conduct the 270/271 transaction for you. This list of current DHS-registered clearinghouses shows which clearinghouses provide 270/271 services.

Resources

• Third-Party Carrier Code List (revised 10/08): If your eligibility verification resource only lists a 4-digit code for the client's third-party resource, refer to this list. It provides the carrier name and contact information for each carrier code.
• OHP Benefit Package and Copayment Chart (revised 12/08): Refer to this chart for a quick reference of OHP-covered services and copayment information.
• OHP Managed Care Carrier Code List (revised 1/09): If your eligibility verification resource only lists a 4-digit code for the client's managed care plan, refer to this list. It provides the county and plan name for each code.

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