MedicaidAdministrativeHigh impact
Provider Announcement
Oregon Health Plan·OR·Plan contract
Effective date
Jan 1, 2020
We identified it
Jun 20, 2026
Summary
Oregon Health Plan (Medicaid) CCOs must implement new Personal Injury Lien (PIL) procedures effective January 1, 2020, with compliance required by July 1, 2020. Key changes include: notifying PIL of third-party liability within 30 days, obtaining lien assignments before seeking reimbursement, perfecting liens for claims ≥$1,000, submitting monthly PIL case reports, and obtaining prior written approval before compromising any assigned lien. CCOs must also create a lien release template compliant with ORS 416.560.
Action Required
By July 1, 2020: Billing and claims team must implement the following PIL procedures: (1) Establish workflow to notify PIL of all identified third-party liability within 30 days of knowledge; (2) Update billing system to prevent any reimbursement requests from members without prior PIL lien assignment approval; (3) For claims ≥$1,000, establish process to perfect liens with county where tortfeasor resides and provide PIL administrative notice within 10 days; (4) Implement automated monthly PIL reporting by the 5th business day after month-end for all active, compromised, closed, and terminated PIL cases (retroactive to 01/01/2020); (5) Create and implement a lien release template conforming to ORS 416.560; (6) Update billing policies to require prior written PIL approval before any lien compromise is pursued. Ensure all staff handling third-party claims and subrogation understand PIL payment priority (PIL liens are paid before CCO liens). Consequences of non-compliance include potential claim denials, loss of recovery rights, and breach of CCO contract obligations.