Pharmacy Coverage Updates Effective October 15, 2018
Pharmacy Coverage Updates Effective October 15, 2018

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Pharmacy Coverage Updates Effective September 17, 2018
Pharmacy Coverage Updates Effective September 17, 2018

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Injection Codes - Removal of Preapproval Requirement
Injection Codes - Removal of Preapproval Requirement

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Inpatient Stay Update – only one IP reference number per stay
This post contains information regarding the Inpatient Stay review format.

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Medical Nutrition Therapy referral requirement

Medical Nutrition Therapy referral requirement



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New Prior Authorization Requirements for Contact Lenses- Effective 07/29/2018

New Prior Authorization Requirements for Contact Lenses - Effective 07/29/2018

 



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Free 1-hour training module with CMEs – Changing the Conversation About Pain: Pain is Everyone's Job
Free 1-hour training module with CMEs – Changing the Conversation About Pain: Pain is Everyone's Job
Lisa Millet, OHA Public Health Injury and Violence Prevention


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Record Retention Guidelines
An update has been made as of January 1, 2018, for Record Retention. More information can be found in this post.

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Holding Claims for Pricing Based on the July 2018 FISS Release
CMS is placing all IP claims (PART A) on a hold for dates of service on/after July 1, 2018 while the pricing files are being updated.  This will ensure proper payment going out.  

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Support for New Mothers in Central Oregon
St Charles is hosting support groups for new mothers. More information can be found in this posting.

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Pharmacy Coverage Updates Effective June 25, 2018
Pharmacy Coverage Updates Effective June 25, 2018

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Updated "Incident to" billing policy - Effective 6/1/18

PacificSource allows “incident to” billing for caregivers who are not eligible to be credentialed by PacificSource or a delegated credentialing entity.  This provides practices the opportunity to fully utilize their staff appropriately.  PacificSource does NOT allow incident to billing for practitioners who are eligible for credentialing. 

Effective June 1, 2018, in order for a service to be considered for payment under the “incident to” billing policy, the modifier SA must be appen

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Upcoming Provider Education Series hosted by the State of Oregon
The State of Oregon has upcoming Provider Education Series.  You can find information regarding these opportunities here. Please reach out to OHA for further information

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New Prior Authorization Requirements for Incontinence Supplies
Incontinence Supplies will require prior authorization effective 5/6/2018

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Prolotherapy and Nail Debridement
Update to Prolotherapy and Nail Debridement processes

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New Claims Research Request Process
An update to the claim research requests through Provider Service Representatives has been made and information on this new procedure is outlined here. The new process will begin on April 2, 2018

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Pharmacy Coverage Updates Effective March 15, 2018
Pharmacy Coverage Updates Effective March 15, 2018

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Therapy year changed to calendar year effective 01/01/2018
Please review updated Therapy visits guidelines regarding calendar year vs. rolling year.

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New CPT and HCPC codes effective
New CPT and HCPC codes have been added to the Pre-Approval Grid for Medicaid services. Please find more information within this update:

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HEDIS Webinar for providers
Please join us for a webinar that will answer questions regarding the upcoming HEDIS Audit

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2018 Updates for Medicare /Medicaid Coding
Please find 2018 coding updates for Medicare and Medicaid within this post.

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2018 Tele Medicine billing update
the GT modifier will no longer be required on approved Tele Medicine procedures for 2018

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Oral Devices Pre Approval Requirements

Effective 01/01/2018: oral devices preapproval required



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Pharmacy Coverage Updates Effective January 1, 2018
Pharmacy Coverage Updates Effective January 1, 2018

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Pharmacy Coverage Updates Effective December 1, 2017
Pharmacy Coverage Updates Effective December 1, 2017 

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Effective 01/01/2018: Removal of Home Health Pre-approval for in-network providers
For In-network providers, PA's will no longer be required for Home Health Care. More information can be found in this post.

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Updated Preapproval for cataract procedures

New procedure information for cataract procedure reqirements as of January 1, 2018 can be found here.



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Time-Based Codes
Requirements for submitting claims with Time-Based Codes can be found here.

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Upcoming Medical Assistant Workshop
Information regarding Workshop for Medical Assistants

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Pharmacy Coverage Updates Effective November 1, 2017
Pharmacy Coverage Updates Effective November 1, 2017

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