MedicaidAdministrativeLow impact
Notices of Adverse Benefit Determination sample for January-March 2025
Oregon Health Plan·OR·Plan
Effective date
Jan 1, 2025
We identified it
Aug 19, 2026
Summary
Oregon Health Authority (OHA) is waiving the requirement for Coordinated Care Organizations (CCOs) to submit samples of Notices of Adverse Benefit Determination (NOABDs) and corresponding Prior Authorization documentation for Q1 2025 (January-March). This is a temporary administrative relief that does not eliminate other grievance and appeal system requirements. Billing teams should note this applies only to Oregon Medicaid CCOs and does not affect standard claims processing or prior authorization workflows for individual patient care.
Action Required
No immediate action required for standard billing operations. This waiver is administrative guidance for CCOs submitting compliance documentation to OHA, not a change to patient billing, prior authorization processes, or claims submission. If your practice is contracted with an Oregon CCO as a provider, no workflow changes are necessary. Continue normal prior authorization and adverse benefit determination procedures for individual patient claims.