Reminder: Corrected Claims for COB Where Medicaid is Secondary.

Corrections need to be made to the primary claim as these claims are crossed over.  If you correct the Medicaid claim only and the services are covered by Medicare or Commercial, this claim will erroneously create a new Medicare or Commercial claim for processing. 

Claims are crossed over from PacificSource Medicare and PacificSource Commercial to PacificSource Community Solutions for Coordination of Benefits.

Retro Pre-Approvals

In order to better align with the Oregon Health Authority, effective February 1, 2021  Pacificsource Community Solutions will now allow retro pre-approval requests for up to 90 days from the date of service.

Pre-approvals may be given a past date of service if:

• The member was made retroactively eligible or was retroactively disenrolled from a CCO or PHP on the date of service.

• The provider has not already billed for the service and/o

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Our NEMT brokerage ModivCare formally known as LogistiCare is operating under Inclement Weather Conditions in some areas of Oregon.

Dear Provider’s

Our NEMT brokerage ModivCare formally known as LogistiCare is operating under Inclement Weather Conditions in some areas of Oregon.

Please know that they are prioritizing those appointments that are considered critical care – e.g. dialysis, chemo, radiation therapy, etc. In addition they are also working to reroute those and/or reschedule others that are non-critical care.