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Oregon Health PlanMedicaid · Prior Auth · Provider · OR · Pediatrics, PsychiatryHigh impact

Single standard prior authorization request process to begin Nov. 1, 2026

Act
by Oct 31, 2026
Effective date
Nov 1, 2026
Identified
Sep 29, 2026

Summary

Effective November 1, 2026, Oregon Health Authority (OHA) will consolidate Behavior Rehabilitation Services (BRS) prior authorization into a single standard process, eliminating preliminary, retroactive, and reauthorization PA types. The review timeline is shortened from 10 business days to 7 calendar days, with an optional 14-day pend period for additional information requests. Providers must submit only standard PA requests after October 31, 2026, or risk claim denials.

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What to do

by Oct 31, 2026 · 5 steps
01Billing team must transition all BRS prior authorization workflows to submit ONLY standard PA requests—eliminate retroactive, preliminary, and reauthorization request types from billing processes and templates.
02Update billing system rules, encounter forms, and provider communication materials to reflect the new 7-calendar-day review timeline and 14-calendar-day pend period.
03Train all staff submitting BRS PAs on the new single-process requirement.
04Coordinate with providers to ensure no retroactive or preliminary requests are submitted after the effective date, as these will not be processed and may result in claim denials.
05Note: Federal Medicaid regulations prohibit payment for services provided before the PA approval date.

Original notice

Single standard prior authorization request process to begin Nov. 1, 2026
oregon.gov · Always check the source before changing claims.
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Related changes

See all Oregon Health Plan changes →
Required training to learn new prior authorization processes effective June 1, 2024HighEffective Jun 1, 2024 · ProviderTechnical assistance for Behavior Rehabilitation Services prior authorization processes effective June 1, 2024HighEffective Jun 1, 2024 · Community partnerProvider forum on updates to Behavior Rehabilitation Services prior authorization processes effective June 1, 2024HighEffective Jun 1, 2024 · ProviderUrgent BRS prior authorization requests to end Nov. 11, 2024HighEffective Nov 11, 2024 · ProviderBrowse every Oregon Health Plan change in the policy list

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Oregon Health Plan policiesOR policy changesPediatricsPsychiatry

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