Mental Health Provider

The ICD-10 Prioritized List can be found at the following webpage:

A searchable version of the Prioritized List of Health Services is available here.

Mental health reporting forms

Complaint forms for OHP and non-OHP members are located on the Get Informed page. Forms in additional languages are available upon request.

Mental health provider contract exhibit forms

Mental health treatment request forms

Directions are as follows for this Psychological Testing Authorization Request (PTAR) Form:

To request psychological evaluations, please complete a (PTAR) form and submit supporting clinical documentation.The following information should be included for the request to be considered for review:
     1. PTAR with completed supplemental questions. 
     2. Mental Health Assessment (within last 60 days); updated treatment plan and needs.
     3. Submit any additional clinical justification and documentation to support request for authorization. 

Please note: MMH authorizes payment at a rate of $110/hour with max of $880 for psychological evaluations. 
*Neuropsychological Assessments or assessments related to medical conditions are the responsibility of member's capitated medical plan and requests must be made through medical insurance not behavioral/mental health. 

Please submit complete requests to Multnomah Mental Health Utilization Review by secure email to or by fax to 503-988-3137.

Multnomah Mental Health

State and Health Share / Multnomah Mental Health Contracts