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
 Effective April 15, 2019 the age requirement will change for screening mammogram 77067. No PA will be required for ages 30 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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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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