MedicaidPrior AuthMedium impact
Changes to the continuity of care disenrollment process, effective February 1, 2017
Oregon Health Plan·OR·Provider
Effective date
Feb 1, 2017
We identified it
Jun 20, 2026
Summary
Oregon Health Authority (OHA) standardized the continuity of care disenrollment process for Oregon Health Plan (OHP) members seeking fee-for-service coverage. Members must now complete form OHP 416 and submit to their PCP, who then requests medical review through OHA's prior authorization process. Prior auth decisions are tracked under PA Assignment 'Fee-for-Service OHP' with code G9399.
Action Required
By February 1, 2017 (effective date): Providers must implement new workflow for continuity of care disenrollment requests. (1) Educate patients that they must complete OHP 416 form and provide to their PCP. (2) Providers/billing staff must submit completed OHP 416 form plus letter of medical necessity and supporting records through OHA's prior authorization process (PA Line: 1-800-642-8635 or 503-945-6821). (3) Update billing system to track CCO disenrollment decisions under PA Assignment 'Fee-for-Service OHP' with code G9399. (4) Inform patients of PA approval/denial notices. Note: This process does NOT apply to American Indian/Alaska Native members (OHP 720 form) or Medicare members (OHP 7209 form), who may continue requesting disenrollment without medical necessity approval. Failure to follow new process may delay or deny continuity of care requests.