MedicaidAdministrativeHigh impact
Transition to Comagine Health - New Independent Qualified Agent effective July 1, 2020
Oregon Health Plan·OR · Psychiatry, General Practice, Occupational Therapy +2 more·Provider
Effective date
Jul 1, 2020
We identified it
Aug 19, 2026
Summary
Oregon's Oregon Health Authority is transitioning Independent Qualified Agent (IQA) responsibilities from KEPRO to Comagine Health effective July 1, 2020. This affects prior authorization processing, utilization review, and assessments for Medicaid beneficiaries receiving 1915(i) HCBS services and fee-for-service behavioral health services. Billing teams must redirect all prior authorization requests to Comagine Health starting July 1, 2020.
Action Required
By June 30, 2020: Billing team must continue submitting all 1915(i) requests and prior authorizations to KEPRO until end of business. Starting July 1, 2020: Route all 1915(i) prior authorization requests and behavioral health service prior authorizations to Comagine Health instead of KEPRO. Update billing software, provider manuals, and internal workflows to reflect the new IQA contractor. Before June 17, 2020: Ensure billing staff register for and attend Comagine Health's introductory webinar (June 17, 2020) to understand new documentation requirements, communication procedures, and service models. Contact Alise Campbell (alise.v.campbell@dhsoha.state.or.us, 503-983-6080) if registration materials were not received or for introductory meetings. Failure to redirect requests to Comagine Health after July 1 will result in delayed processing and potential claim denials.