MedicaidAdministrativeMedium impact
Notice of Adverse Benefit Determination requirements
Oregon Health Plan·OR·Plan contract
Effective date
Jul 1, 2021
We identified it
Jun 20, 2026
Summary
Oregon Health Authority clarifies that Medicaid managed care organizations must issue written notices to members for all claim denials, formally rescinding previous 2015 guidance that exempted plans from this federal requirement. This affects billing workflows for practices serving Oregon Medicaid patients.
Action Required
Immediately: Billing team should verify that Oregon Medicaid managed care plans are issuing written notices to patients for denied claims. If patients report not receiving denial notices, contact the MCO to ensure compliance. This primarily affects patient communications rather than billing procedures, but may impact appeal processes and patient inquiries about denied services.