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Oregon MSC 3971: ODHS|OHA Prior Authorization Request

MSC 3971 is the paper request for fee-for-service (open card) Oregon Health Plan prior authorization of medical and dental services, such as procedures, imaging and durable medical equipment. OHA asks providers to use it only when they cannot submit through the MMIS Provider Portal. Its first page is the MSC 3970 EDMS coversheet, so each faxed request is scanned and tracked on its own.

Who completes it

The requesting provider completes the form, including the client's ID, the requesting, performing and referring provider NPIs, diagnosis, service codes and units, and a written justification, and attaches the clinical documentation their program's guidelines require.

Submitting and payment

How to submit it
Fax it with its coversheet to OHA's routine or immediate/urgent PA fax line, or enter the request in the Provider Portal instead. For an update, put the existing PA number on the coversheet or it is treated as new.
Who pays
Approval does not guarantee payment: the client must be eligible on the date of service, program limits still apply, and OHA reduces its payment by any third-party payment.

Good to know

  • Routine requests may take up to five days. Choose urgent for 72-hour or immediate for 24-hour processing, and state why in the notes with supporting documents.
  • OHA automatically denies requests for clients who are not eligible on the date of service or whose managed care plan covers the service, so verify enrollment first.
  • Use one coversheet per request, with your NPI and the client's ID and the Prior Authorization box marked. OHA will not accept faxed requests without it.
  • The form was updated in December 2025 and is not used for medical review of CCO disenrollment requests. Send only the documentation needed, since extra pages can slow review.

Get the official form

Download the current version from the source each time; forms change without notice.

ODHS|OHA Prior Authorization Request

Official pagePDF

Fill it with Vero

If your copy of the form is a fillable PDF, upload it once and Vero Documents fills it from the visit note and the chart, ready for you to review and sign. Download, print, or email the finished form, with the patient’s consent.

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How this list is checked

A form is listed only after its name and number were confirmed on the issuing agency’s or insurer’s own website, or in the form itself. Each entry links to that source. The list was last checked in October 2026. Forms and their requirements change without notice, so check the official page for the current version before you complete one.

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Frequently asked questions

Do CCO members use the Oregon MSC 3971?

No. The MSC 3971 applies to fee-for-service, or open card, Oregon Health Plan members. For services covered by a patient's coordinated care organization, OHA tells providers to follow the CCO's own prior authorization procedures, and requests for clients enrolled in a plan that covers the service are automatically denied.

How fast does OHA process a fee-for-service prior authorization?

OHA's guidance says routine processing may take up to five days. Urgent requests are processed in 72 hours and immediate requests in 24 hours, but only if the request states it is urgent or immediate and explains why. OHA no longer calls with status; check the PA Inquiry function in the Provider Portal.

How do I add records to an existing Oregon fee-for-service PA?

Either open the request in the Provider Portal by searching its prior authorization number and upload the documents there, or fax a new MSC 3971 with the documentation. When faxing, put the existing PA number on the MSC 3970 EDMS coversheet so OHA does not process it as a new request.