Hi, @John McComb ,
First, event with the preview Email OTP feature, the external user still cannot be treated as a guest account which your created in the Azure AD.
Per my knowledge and test, if you want to opt in to the preview Email OTP feature, you will need to run the PowerShell cmdlet to get it work. After that, once you share contents to an account outside your organization , still the recipient receives an email and does have access but needs to request and enter a one-time passcode each time they connect.
After the user signs in, there will be an automatically created guest account in Azure AD you can check. However it is a guest account from OTP which will cannot be added to groups. The account will not appear in people picker. You can view guest users who authenticate with one-time passcodes in the Azure portal by going to Azure Active Directory > Users.
Reference: https://learn.microsoft.com/en-us/azure/active-directory/external-identities/one-time-passcode
You may open a service request or contact with SharePoint consultant for other possible solutions.
If the answer is helpful, please click Accept Answer and upvote it.
Note: Please follow the steps in our documentation to enable e-mail notifications if you want to receive the related email notification for this thread.