Form OHP3103 Provider Enrollment Attachment - Targeted Case Management - Oregon

Form OHP3103 Provider Enrollment Attachment - Targeted Case Management - Oregon

What Is Form OHP3103?

This is a legal form that was released by the Oregon Health Authority - a government authority operating within Oregon. As of today, no separate filing guidelines for the form are provided by the issuing department.

FAQ

Q: What is Form OHP3103?
A: Form OHP3103 is a Provider Enrollment Attachment for Targeted Case Management in Oregon.

Q: What is Targeted Case Management?
A: Targeted Case Management is a service that helps individuals with complex health needs navigate the healthcare system and access necessary services.

Q: Who should complete Form OHP3103?
A: Providers who offer Targeted Case Management services in Oregon should complete Form OHP3103.

Q: Is Form OHP3103 mandatory for Provider Enrollment?
A: Yes, providers offering Targeted Case Management services in Oregon must complete Form OHP3103 for enrollment.

Q: Are there any specific requirements for completing Form OHP3103?
A: Yes, providers must ensure that all required fields are filled out accurately and provide supporting documentation as requested.

Q: Who can I contact for help with Form OHP3103?
A: For assistance with Form OHP3103, you can contact the Oregon Health Plan Provider Enrollment department.

Q: What other documents may be required for Provider Enrollment?
A: In addition to Form OHP3103, providers may be required to submit other documents such as proof of licensure, certifications, or professional liability insurance.

Q: Is there a deadline for submitting Form OHP3103?
A: The deadline for submitting Form OHP3103 may vary, so it is important to check with the Oregon Health Plan for the latest information.

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Form Details:

  • Released on February 1, 2022;
  • The latest edition provided by the Oregon Health Authority;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;
  • Fill out the form in our online filing application.

Download a fillable version of Form OHP3103 by clicking the link below or browse more documents and templates provided by the Oregon Health Authority.

Download Form OHP3103 Provider Enrollment Attachment - Targeted Case Management - Oregon

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