Thank you for your interest in joining Central Oregon IPA. The current version of the Oregon Practitioner Credentialing Application may be accessed online in both Word and PDF fillable formats, at http://www.oregon.gov/oha/OHPR/ACPCI/Pages/state_app.aspx
In addition to the application, please find the following COIPA-specific documents:
- A Initial Applicant Coipa Cover letter rev 10-2015 – Explains membership criteria, practitioner rights, credentialing process and serves as membership dues invoice.
- Membership Request Form
- COIPA Outpatient/Inpatient Call Coverage Form
- Participating Provider Agreement (PPA) – Physician or Participating Provider Agreement (PPA) – Associate
- Amendment to PPA – Physician or Amendment to PPA – Associate – Pertains to Medicare
- Business Associate Agreement Sept 2014 Final – Pertains to HIPAA
Once you have completed the packet, you may return it via email at firstname.lastname@example.org or by fax at (541) 585-2591.