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
Effective 01/01/2018: oral devices preapproval required