Inpatient stay review process changing Oct. 1
Effective October 1, 2026, CareOregon will begin conducting concurrent reviews for inpatient stays at DRG hospitals. Rather than approving an entire stay at time of admission, CareOregon will review the member’s condition for ongoing medical necessity.
For facilities where CareOregon has access to the electronic medical record (EMR), no additional action is required. If CareOregon does not have EMR access, facilities may need to provide documentation more frequently to support continued stay reviews.
If a continued stay is denied and a member is discharged as a result, members can submit an appeal.
CareOregon is making this change to support consistent, timely review of inpatient stays and confirm that continued inpatient care remains medically necessary. This helps ensure members receive care at the appropriate level for their needs, while aligning our process with clinical guidelines and standard utilization management practices.
Questions about this change? Contact Provider Customer Service at 503-416-4100.