MedicaidAdministrativeHigh impact
Transition to Comagine Health - New Independent Qualified Agent effective July 1, 2020
Oregon Health Plan·OR · Psychiatry, General Practice·Provider
Effective date
Jul 1, 2020
We identified it
Jun 20, 2026
Summary
Effective July 1, 2020, Comagine Health becomes Oregon's new Independent Qualified Agent (IQA), replacing KEPRO for prior authorizations, utilization review, and assessments for Medicaid 1915(i) HCBS services and behavioral health services. The IQA's responsibilities expand to include State Plan Personal Care coordination, conflict-free case management for residential behavioral health clients, and increased person-centered planning monitoring. All prior authorization requests must be redirected from KEPRO to Comagine Health starting July 1, 2020.
Action Required
By June 30, 2020: Billing team must stop submitting 1915(i) requests and prior authorizations to KEPRO and prepare to route all submissions to Comagine Health effective July 1, 2020. Update billing system contact information and routing rules to direct behavioral health prior authorizations to Comagine Health instead of KEPRO. Before July 1, 2020: All behavioral health providers, community mental health programs, and residential treatment facilities must attend Comagine Health's introductory webinar on June 17, 2020 (or register on their website if the invite was not received) to understand new documentation requirements, service coordination processes, and communication procedures. After July 1, 2020: Submit all prior authorization requests for 1915(i) HCBS State Plan Option services, non-1915(i) fee-for-service behavioral health services, State Plan Personal Care coordination, and residential behavioral health assessments to Comagine Health. KEPRO will automatically redirect requests submitted after June 30, 2020. Failure to transition submissions will result in processing delays and potential claim denials. Contact Alise Campbell (alise.v.campbell@dhsoha.state.or.us or 503-983-6080) for questions or to request introductory meetings with Comagine Health.