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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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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