OUT OF NETWORK PROVIDERS

Umpqua Health Alliance (UHA) is a Medicaid Health Plan in Douglas County, Oregon. UHA strives to make the Oregon state DMAP enrollment process as smooth as possible in order for you to be able to submit claims to UHA and be paid for valuable services provided to our Member while at your facility. Please note that billing the Member directly is prohibited by Oregon state OARs.

Enrollment

Please provide your contact information on all submissions, including your 1) Name 2) Email 3) Phone Number 4) Has a claim already been submitted? (Yes or No). *If no, please do not delay submitting it as it may affect the 120 day timely filing requirement. If you have submitted your claim(s) and received a denial, your claim should auto-reprocess once your DMAP number has been posted to the State’s weekly DMAP Provider file.

Enroll a Facility

Please complete the following forms along with supporting documents and the contact information above.

Required Forms

Required Documentation

  • Business state license
  • IRS Letter
  • W9

Fax or email all documents and information above to:

Umpqua Health Alliance
Lorianne Heard, Contract Specialist
E: lheard@umpquahealth.com
Fax: 541-440-6306
Ph: 541-957-3094

Enroll a Provider

A separate form will need to be completed for each rendering provider. If the facility already has an active Oregon DMAP number, and only the rendering provider needs enrolled, as long as you have the provider’s NPI, date of birth, and social security number, you will be save time completing paperwork by calling, and enrolling your provider over the phone.

Required Forms

Required Documentation

  • Business state license
  • IRS Letter
  • W9

Fax or email all documents and information above to:

Umpqua Health Alliance
Lorianne Heard, Contract Specialist
E: lheard@umpquahealth.com
Fax: 541-440-6306
Ph: 541-957-3094

Contact Us

For all contracting questions, please contact us at UHNProviderServices@umpquahealth.com.

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