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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Alternative Therapies New Requirements
New Requirement for Alternative Therapies can be found here:

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New OHA DMAP Requirement/Edit
Please click on the read more link to find out detailed information on this requirement.

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American Cancer Society new ECHO interactive colorectal screening tool
The American Cancer Society is partnering with RMPHTC to launch a new interactive tool regarding colorectal screenings.  

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Home Health Update from Oregon Health Authority – Temporary Administrative Rules
Information regarding this update can be found at the link within this post:

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Medicaid Compliance Training Notification
Letters were mailed to Medicaid Providers Regarding Annual Compliance Training

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Pharmacy Network Change Effective August 1, 2017
Pharmacy Network Change Effective August 1, 2017

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Pharmacy Coverage Updates Effective September 15, 2017
Pharmacy Coverage Updates Effective September 15, 2017

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Our Medicaid Provider Panel is looking for Behavioral Health providers in Central Oregon and the Gorge
PacificSource Community Solutions maintains a closed behavioral health panel for our Medicaid members in Central Oregon and the Gorge. In order to better serve our members’ needs, we are seeking additional behavioral health providers to be part of this panel. Click READ MORE for detailed information.

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Update to Medicaid HCPC codes
There has been an update to the OHA HCPC codes as outlined in this post. Please contact PacificSource Community Solutions with any questions. Thank you!

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Pain Management Treatment Update
PacificSource has added information to the current Pain Management treatment guidelines.  

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Update for PT, OT, and ST Services
Please review a change to the PT/OT/ST services effective June 17, 2017.

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Hemophilia Clotting Factor Billing
PacificSource Community Solutions covers blood clotting factors and related items used for the administration of such factors for hemophilia patients competent to use such factors without medical supervision. Please refer to the body of this post for specific information:

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Pharmacy Coverage Updates Effective July 15, 2017
Pharmacy Coverage Updates Effective July 15, 2017

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Pre-Approval Change for CPT codes 45378-45398
There has been a change to the Pre-Approval process for Colonoscopy cpt codes

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Policy Update: Hospital Bed Coverage
An update has been made to the PacificSource Hospital Bed Coverage for Medicaid. 

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Coverage Update Effective May 18, 2017

Effective May 18, 2017, CPT 98925 will require a preapproval. 



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Hospital and CAH- Provider-Based Billing Services
An update to the Medicaid policy for Provider-based billing services can be found here.  Please contact your Provider Representative if you have any questions.  Thank you. 

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Pharmacy Coverage Updates Effective May 22, 2017
Pharmacy Coverage Updates Effective May 22, 2017

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Pharmacy Coverage Updates Effective May 1, 2017
Pharmacy Coverage Updates Effective May 1, 2017

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Errata to the 01/01/2017 Oregon Health Authority Prioritized List
Update to the Errata codes can be found here.

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Smoking Cessation and elective surgical procedures
An updated smoking cessation guideline for elective surgical procedures can be found here.  Please contact your Provider Service Representative with any questions.  Thank you.

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February is Heart Health Month
February is Heart Health Month: Celebrate by Maintaining a Healthy Blood Pressure

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Long-Acting Reversible Contraceptive Placement (LARC)
New payment guidelines have been established for Long-Acting Reversible Contraceptive Placement.  Please read the details below. 

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Upcoming Clinical Diabetes Workshop Information
An upcoming provider workshop relating to Chronic Disease Management of Prediabetes. This presentation does count towards CME Credits.

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Prior Authorization and Referral Information
PacificSource Prior Authorization (PA) and Referral Guideline can be found here.  Please contact your Provider Service Representative if you need clarification or have any questions.

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Coordination of Benefits (COB) Policy
PacificSource COB policy information can be found here. Please contact your Provider Service Representative if you need further clarification or have any questions.

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Free Workshop for Medical Assistants
Yearly Testing and Preventive Care Best Practices

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