Oregon Medicaid — Oregon Health Plan (OHP / Oregon Medicaid)
| Program name | Oregon Health Plan (OHP / Oregon Medicaid) |
|---|---|
| Provider portal | https://www.oregon.gov/oha |
| FFS claims payer ID | No single canonical ID — routing is fiscal-intermediary-specific. Verify per clearinghouse. |
| Medicaid timely filing | 365 days from date of service |
The federal ceiling for Medicaid timely filing is 12 months under 42 CFR §447.45; most states set a shorter window. Always verify the current policy on the Oregon Medicaid provider portal before filing a late-billing appeal.
BCBS licensee in Oregon
The Blue Cross Blue Shield Association licensee in Oregon is Regence BlueCross BlueShield of Oregon. See the Regence payer guide for payer ID, timely filing, prior auth, and appeal procedures.
Top commercial payers in Oregon
The dominant commercial insurers operating in Oregon, in approximate order of lives covered. Click through for per-payer claims payer IDs, timely filing windows, prior-authorization rules, and appeal procedures.
Medicaid MCOs in Oregon
Oregon Health Plan (OHP / Oregon Medicaid) contracts with the following managed-care organizations to administer Medicaid benefits in Oregon. MCO contracts dictate claims routing, prior-auth workflows, and appeal deadlines — route each claim by the member's MCO assignment, not the state FFS payer ID.
State-specific regulations affecting Oregon billing
- ORS §743B.287 (Oregon Balance Billing Protection Act, HB 2339 of 2017)
- ORS §743B.225 (prompt pay — 30 days electronic clean claim)
- ORS §442.460 (hospital financial assistance / community benefit)
Provider licensing & enrollment in Oregon
Providers enroll via OHP Provider Enrollment (OHA). CCOs use centralized credentialing vendors per OAR 410-141-3515.
Major health systems headquartered in Oregon
| Health system | Headquarters |
|---|---|
| Providence Health & Services (Oregon) | Portland, OR |
| Legacy Health | Portland, OR |
| OHSU (Oregon Health & Science University) | Portland, OR |
| Kaiser Permanente Northwest | Portland, OR |
| Asante Health System | Medford, OR |
Frequently asked questions — Oregon billing
What is the Oregon Medicaid program called?
Oregon's Medicaid program is known as Oregon Health Plan (OHP / Oregon Medicaid). Providers enroll and manage claims through the provider portal at https://www.oregon.gov/oha.
What is the Oregon Medicaid timely filing limit?
Oregon Health Plan (OHP / Oregon Medicaid) requires initial claims to be filed within 365 days from the date of service. The federal ceiling is 12 months under 42 CFR §447.45; Oregon's 365-day window is set by the state provider manual. Late-billing exceptions may be allowed with good-cause documentation — verify on the state portal before filing an appeal.
Does Oregon Medicaid publish a single claims payer ID?
No single canonical claims payer ID is published for Oregon Health Plan (OHP / Oregon Medicaid). Claims route through the state's fiscal intermediary; look up the correct submitter ID in your clearinghouse directory (Availity, Change Healthcare/Optum, Waystar) and route managed-care claims by the member's MCO assignment.
Who are the largest commercial insurers in Oregon?
The dominant commercial payers in Oregon include Regence, Providence Health Plan, Kaiser Permanente, UnitedHealthcare, Aetna, along with the BCBS licensee Regence BlueCross BlueShield of Oregon. Each payer's claims routing, timely filing, and prior-auth rules differ — see the per-payer guides linked above.
What Medicaid managed-care organizations operate in Oregon?
Oregon Health Plan (OHP / Oregon Medicaid) contracts with 3 Medicaid MCOs tracked in the QuickIntell registry, including Providence Health Plan, Centene, UnitedHealthcare. MCO contracts determine claims routing and appeal deadlines — route each claim by the member's MCO assignment, not by the FFS payer ID.
What state-specific billing regulations apply in Oregon?
Oregon has 3 tracked state-level statutes that affect medical billing and RCM: ORS §743B.287 (Oregon Balance Billing Protection Act, HB 2339 of 2017); ORS §743B.225 (prompt pay — 30 days electronic clean claim); ORS §442.460 (hospital financial assistance / community benefit). These sit on top of federal protections such as the No Surprises Act, HIPAA, and 42 CFR §447.45.
Run cleaner claims in Oregon with QuickIntell
QuickRCM, QuickAuth, and QuickERA are tuned to Oregon Health Plan (OHP / Oregon Medicaid) and the commercial payers on this page — eligibility, prior auth, claim scrubbing, and ERA posting all run on real payer rules, not generic adapters.
Disclaimer
This page is operational reference for medical-billing professionals. It is not legal, clinical, or contractual advice. State Medicaid policies, MCO contracts, and payer rules change without notice — always verify against the current provider manual from Oregon Medicaid and the member ID card before submission.