New Prior Authorization Requirements for Contact Lens Fitting - Effective 8/12/19
New Prior Authorization Requirements for Contact Lens Fitting Effective 8/12/19

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PacificSource Community Solutions Notified by OHA of Intent to Award Four CCOs
Lane, Marion, Polk, Gorge and Central Oregon CCOs expected to be awarded

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Training: One Key Question® Certification and the Reproductive Health Equity Act
One Key Question® certified training opportunity

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Behavioral Health InPatient Notification
Behavioral Health InPatient Notification

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Oregon Dual Members Non-Covered Medicare Service
Non-Covered Medicare Service

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Vision Therapy

Effective July 1, 2019 Vision Therapy will require a prior authorization (PA). Vision therapy is covered for children through age 20, with a covered diagnosis per the Prioritized List of Health Services.



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New Medicaid Provider Validation Process
PacificSource has recently implemented a new validation/oversight process for Medicaid eligible practitioners who do not qualify for full credentialing. These provider types include, but are not limited to, traditional health workers, addiction counselors, qualified mental health professionals/associates, and providers who are licensed but practice under supervision (ie. Psychologist Resident, Licensed Professional Counselor Intern, etc).

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Medicaid Provider Billing: Tax-ID vs Social Security Number (SSN) Update Effective 11/1/2019

Effective 11/1/2019 PacificSource Community Solutions will start denying provider claims for providers that are billing with either their Tax-ID number or Social Security Number (SSN) if the information billed doesn’t match what the State has on file. Updates must be made through us PacificSource Community Solutions .



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Medicaid Inpatient Professional Claims Submitted on CMS 1500 forms
Medicaid Inpatient Professional Claims Submitted on CMS 1500 forms

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Rules for OHA's Continued Financial Support for Full Treatment of Hepatitis C Medications
Rules for OHA's Continued Financial Support for Full Treatment of Hepatitis C Medications

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AIM Genetic Testing Program Webinar
AIM Genetic Testing Program Webinar

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AIM Genetic Testing Prior Authorization Change Effective July 1, 2019
AIM Genetic Testing Prior Authorization Change Effective July 1, 2019

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Pharmacy Coverage Updates Effective June 15, 2019

Pharmacy Coverage Updates Effective June 15, 2019



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Pharmacy Coverage Updates Effective June 17, 2019
Pharmacy Coverage Updates Effective June 17, 2019 

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Preauthorization (PA) requirements change: Medicaid Behavioral Health codes - Effective 5/20/19

Effective 5/20/2019, PacificSource will not be requiring a PA with the associated codes:



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Upper GI Endoscopy

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.   



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Mammograms
 Update: Effective May 1, 2019 the age requirement will change for screening mammogram 77067. No PA will be required for ages 35 and older. 

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OHA Behavioral Health Update: QMHA & QMHP credentialing timeline

Notice on behalf of the Oregon Health Authority (OHA)

 

In December, OHA announced



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New Provider Enrollment Update: Effective April 1, 2019

 

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.



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Attention Behavioral Health Providers

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.



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Preauthorization (PA) requirements additional update Effective 3/23/2019 - Medicaid Behavioral Health
Preauthorization (PA) requirements additional update Effective 3/23/2019 - Medicaid Behavioral Health

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The Member Insight Report is Your Source for ICCS Identification
We have recently made adjustments to how we notify you about your patients who are eligible for Intensive Care Coordination Services (ICCS).

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Urine drug screening reminders for Medicaid Behavioral Health codes

Urine drug screening reminders for Medicaid Behavioral Health codes



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Preauthorization (PA) requirements change: Medicaid Behavioral Health codes - Effective 3/15/19
Preauthorization (PA) requirements change: Medicaid Behavioral Health codes - Effective 3/15/19

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Pharmacy Coverage Updates Effective April 15, 2019
Pharmacy Coverage Updates Effective April 15, 2019

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Changes to Oregon Health Plan (OHP) prescriber enrollment implementation

 

The Oregon Health Authority (OHA) has postponed implementation of Read More


Duplicate 1099 Forms
Duplicate 1099 Forms

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Lactation Services Referral Requirement Removed Effective 2/1/19
Lactation Services - Referral Requirement removed for Medicaid

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Changes to OHP coverage of Medication-Assisted Treatment effective 1/1/2019

Changes to OHP coverage of Medication-Assisted Treatment effective 1/1/2019



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Donated Breast Milk Benefit Implementation Effective January 1, 2019
Donated Breast Milk Benefit Implementation

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Diabetes Prevention Program (DPP)

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:



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Continuous Glucose Monitors (CGM) - Coverage Update
Continuous Glucose Monitors (CGM) - Coverage Update

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Claims

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



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Gender Affirming Surgery - Preapproval Requirements - Effective December 3, 2018
Gender Affirming Surgery - Preapproval Requirements

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PacificSource Medical Drug Formulary changes, Effective on 01/01/2019

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



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PacificSource Accepting Traditional Medicare Crossover Claims
PacificSource Accepting Traditional Medicare Crossover Claims

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Holding claims for pricing based on October 2018 IPPS release

CMS is placing a claims payment hold on all Inpatient and Long Term Care claims with discharge dates 10/1/18-10/22/18



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Pharmacy Coverage Updates Effective November 19, 2018
Pharmacy Coverage Updates Effective November 19, 2018 

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Medicaid Reassessment Tool Notification

Therapies related to Guideline Note 56 (back and spine)-  Reassessment Tool required for subsequent visits



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

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Alternative Care Visit Limits/Determination – alignment across all therapy modalities.

Alternative Care Visit Limits/Determination – alignment across all therapy modalities.



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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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