Oregon Office of Public Defense Services
198 Commercial St. SE, Suite 205, Salem, OR 97301 • 503.378.2478 • www.oregon.gov/opds
Please complete this form if you would like OPDS to reconsider a decision to deny
payment of all or part of a submitted invoice.
The reconsideration process is in place to assess issues where there is disagreement
regarding the reason payment was denied or amended and additional information
or circumstances may have affected the decision. Issues that are clearly defined by
policy will not be forwarded to the reconsideration panel.
This form is NOT required if you are simply submitting additional information as
noted on a Notice of Adjustment within 60 days of the notice date. The Notice
of Adjustment and needed information may be submitted normally into the
processing que.
This completed form and any additional information is required for reconsideration.
The request must be submitted via email at accountsPayable@opds.state.or.us
RECONSIDERATION REQUEST in the subject line of the email. Requests $10.00 or
over must be submitted within 60 days of the date of the Notice of Adjustment. If
under $10.00 within 60 days of the payment date. Requests will be reviewed by the
Reconsideration Panel for approval or denial within 10 business days of receipt.
Payment Voucher Number _________________________________________
Please check all that apply
There are other related payments See attached
Please summarize what was not paid and the circumstances or additional information that
has been included to support payment.