Currently 43248 Upper GI Endoscopy w/insertion of Guide Wire/Dilatation requires a Prior Authorization (PA). Effective April 15, 2019 the PA requirement will be removed. This code will no longer require a PA.
Notice on behalf of the Oregon Health Authority (OHA)
In December, OHA announced
New Provider Enrollment, the State of Oregon will conduct pre-enrollment and post-enrollment site visits for high and moderate risk provider types. You can find more information regarding this new process on the below link to OHA’s website.
On the behalf of OHA, PacificSource encourages you to visit the below link. Here you will find some great resources offered by OHA, focusing on tobacco dependence treatment in a behavioral health setting.
Urine drug screening reminders for Medicaid Behavioral Health codes
The Oregon Health Authority (OHA) has postponed implementation of Read More
Changes to OHP coverage of Medication-Assisted Treatment effective 1/1/2019
On 01/01/2019, OHA’s diabetic prevention program will be in effect. PacificSource will not be requiring a PA with the associated codes effective January 18th 2019:
Change to sterilization consent requirements effective 1/1/2019
Ambulatory surgical centers can bill OHA for post-procedure long-acting reversible contraceptive placement effective 1/1/2019
This notification is to inform you of changes to our medical drug formulary for all PacificSource Medicare, Medicaid, and Commercial Plans.
Effective on 01/01/2019 our formulary will change
CMS is placing a claims payment hold on all Inpatient and Long Term Care claims with discharge dates 10/1/18-10/22/18
Therapies related to Guideline Note 56 (back and spine)- Reassessment Tool required for subsequent visits
Alternative Care Visit Limits/Determination – alignment across all therapy modalities.
Medical Nutrition Therapy referral requirement
New Prior Authorization Requirements for Contact Lenses - Effective 07/29/2018
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