News and updates

Updates on Existing CriteriaAugust 2024. The following changes to criteria are effective August 22, 2024:Prior Authorization Criteria –...

These updated documents contain policy guidance for the Medicaid Grievance and Appeals System. Grievances Appeals and Hearings Member Information and Education RequirementsNotice of Adverse...

Updates on Existing CriteriaJuly 2024. The following changes to criteria are effective July 22, 2024:Prior Authorization Criteria –...

Clearinghouse services provided by Change Healthcare have been mostly restored, including eligibility status, remittance advice, and claims transmission, following a February cybersecurity event....

Here’s what providers should know if they want to provide health-related social needs (HRSN) services.Qualifications and process for becoming an HRSN service providerTo become an HRSN service...

Important details and what to expect Note: This law applies only to Oregon members who are covered by individual/family and fully insured...

Oregon Senate Bill 1529, now in effect, intends to expand access to care and improve health outcomes. The following is an overview of the law’s key requirements and what you can expect from...

Updates on Existing CriteriaJune 2024. The following changes to criteria are effective June 22, 2024:Prior Authorization Criteria –...

On Wednesday, February 21, 2024, Change Healthcare, one of our clearinghouse partners, was impacted by a cybersecurity event. This event compelled them to suspend business with all...

We have recently updated our prior authorization list and coverage policies. These changes are effective for dates of service on or after May 15, 2024....