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HEALTH PLAN USE ONLY CORP OR/WA/NONA 013DENTAL CLAIM FORM1. COMPLETE THIS FORM 2. ATTACH ALL BILLS 3. MAIL TO:Claims Central PO Box 619031 Roseville, CA 956619031 Phone 8004412524 Fax 9167812441 http://claimscentral.ah.org
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Visit the Oregon Health Authority website at https://www.oregon.gov/OHA/pages/index.aspx
02
Navigate to the 'Forms' section on the website.
03
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The Oregon Health Authority (OHA) is the government agency responsible for overseeing the state's public health system.
Healthcare providers, facilities, and organizations in Oregon are required to file with the Oregon Health Authority.
To fill out the Oregon Health Authority forms, providers need to submit specific information about their services, patients, and finances.
The purpose of filing with the Oregon Health Authority is to monitor and improve the quality, accessibility, and affordability of healthcare in the state.
Information such as patient demographics, services provided, billing data, and quality metrics must be reported on the Oregon Health Authority forms.
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