MedicaidPrior AuthMedium impact
Handling of requests for prior authorization (PA), including during appeals and hearings
Oregon Health Plan·OR·Plan
Effective date
Apr 1, 2025
We identified it
Jun 20, 2026
Summary
Oregon's Medicaid program (OHP) has updated requirements for CCOs handling prior authorization requests, mandating at least 3 outreach attempts using 2 different methods when additional information is needed. CCOs must accept all PA requests regardless of timing and cannot encourage duplicate submissions to bypass the appeals process.
Action Required
Immediately: For Oregon Medicaid patients, understand that CCOs must now make at least 3 outreach attempts using 2 different methods when requesting additional PA information. Billing staff should respond promptly to CCO requests and use formal appeals process rather than submitting duplicate PA requests after denials. Update staff training on proper appeal procedures for Oregon Health Plan members.