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Oregon Health PlanMedicaid · Prior Auth · Plan · ORMedium impact

Healthier Oregon Transition Data Guidance for Prior Authorizations

Effective date
Jan 1, 2027
Identified
Nov 7, 2026

Summary

Oregon's Office of Health Policy (OHA) directed coordinated care organizations (CCOs) to submit prior authorization data for Healthier Oregon members transitioning to the Oregon Health Plan Open Card program, covering approved prior authorizations for prescription, medical, behavioral and oral health services to be rendered on or after Jan. 1, 2027, plus program exception approvals. Practices in Oregon that serve these members should expect prior authorizations to be entered into fee-for-service claims processing on the dates listed, so billing staff should confirm which active authorizations carry 2027 effective dates and that claims reference them correctly.

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What to do

Action · 11 steps
01By Nov.
0216, 2026: Billing team, confirm with the member's CCO which active prior authorizations for Healthier Oregon members have effective dates on or after Jan.
031, 2027, and track any authorization the CCO approves later through Dec.
0418, 2026 or Jan.
054, 2027.
06Front desk and providers should confirm that services scheduled on or after Jan.
071, 2027 for these members have an authorization on file before the visit, and that urgent requests are routed through the CCO's care-coordination process (warm handoff) so that continuity of care is maintained as members move to Open Card.
08In the prior auth tracker, flag any member whose authorization was pended and may not be processed until after Jan.
094, 2027, so claims for those services are not submitted without verifying the authorization status first.
10Claims for services on or after Jan.
111, 2027 without a valid authorization on file will be denied by the payer.

Original notice

Healthier Oregon Transition Data Guidance for Prior Authorizations
oregon.gov · Always check the source before changing claims.
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