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
Umpqua Health Alliance
Tori Hall, Contract Specialist
E: thall@umpquahealth.com
Ph: 458-803-4048
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
Fax or email all documents and information to:
Umpqua Health Alliance
Tori Hall, Contract Specialist
E: thall@umpquahealth.com
Ph: 458-803-4048
Contact Us
For all contracting questions, please contact us at 458-803-4048 or UHNProviderServices@umpquahealth.com.
