Become a provider
Register with DMAP
Important Change! In our efforts to quickly and efficiently process all Oregon Medicaid DMAP enrollment applications received by EOCCO, we are moving to digital only applications. Please note that effective 05/01/2022 applications will only be accepted via email to ProviderDMAPApps@modahealth.com. Any applications received via fax or mail after 05/01/2022 cannot be accepted and we will reach out to you.If you have questions, concerns or difficulties with this process change, please email ProviderDMAPApps@modahealth.com
If you are not registered with DMAP, please complete the managed care plan rendering provider application and the managed care plan facility clinic application, below. You may send these by email to ProviderDMAPApps@modahealth.com.
EOCCO will deny claims from providers who are not registered with DMAP.
Rendering Providers will need to include the following in their application:
- OHA Managed care plan provider application through EOCCO
- A complete and signed Provider Enrolment Agreement 3975 form (included in the application above)
- A copy of an active practitioner license
Facilities/Clinics will need to include the following in their application:
- OHA Managed care plan facility/clinic/provider group application through EOCCO
- A complete and signed Provider Enrolment Agreement 3975 form (included in the application above)
- A copy of current year facility license and any previous year licensees as appropriate for the dates of services that need to be covered in the enrollment request
- A copy of current year business W9
On March 25, 2011, DMAP began requiring all healthcare providers and suppliers to submit both Social Security numbers and date of birth information when they are initially enrolling or revalidating their enrollment with DHS/OHA. This requirement applies to providers contracting with managed care plans or as a non-participating managed care plan provider.
DMAP is taking this action as required under Section 6401 of the Patient Protection and Affordable Care Act (PPACA), signed into law on March 23, 2010. The CMS final rule addressing Section 6401 of the PPACA is CMS-6028-FC. This can be found online at edocket.access.gpo.gov/2011/2011-1686.htm.
This requirement applies equally to each provider or supplier, each person with ownership or control interest in the provider or supplier, any subcontractor that the provider or supplier directly or indirectly has a five percent (5%) or more ownership interest, and any managing employees including directors and officers of corporations, non-profit organizations and charities.
Contracting with EOCCO
Please see the following emails for specific questions or information.
I want to join the panel and initiate a contract as a new provider:
providernominations@modahealth.com
Request to join the EOCCO Behavioral Health network:
Provider Interest Form
I am an existing provider, and I want to renew my contract:
contractrenewal@modahealth.com
I need a copy of my current contract:
providerrelations@modahealth.com
Credentialing information:
credentialing@modahealth.com
Updating demographic information:
providerupdates@modahealth.com
Claim review:
eoccomedical@eocco.com
Adjustment requests:
eoccomedical@eocco.com
Billing policy information:
eoccomedical@eocco.com
Community Health Workers
Before you submit an application with Oregon Medicaid, please ensure that you have your certification and registration through OHA Office of Equity and Inclusion and an active National Provider Identification (NPI).
For more information please see the Community Health Workers DMAP Enrollment and Reimbursement instructions.
