COVID-19 vaccine news for Oregon Health Plan members
Learn more

Provider Notices

We have updated the below notice to reflect the updated name for ‘Board Registered Interns’ to the correct name effective August 6, 2021, to ‘Board Registered Associates’ per Oregon State Legislation.

The below notice is still current. The only change made is relative to the Oregon State Legislation, implementing the immediate name change.

 



Read More

Update as of August 30th 2021- RideSource also known as Lane Transit District’s (LTD) our NEMT brokerage in Lane County is operating under regular capacity. 



Read More

Medicaid Grievance and Appeals Policy Guidance

These documents contain policy guidance for Member Information and Education Requirements, Notice of Adverse Benefit Determination, Grievances Appeals and Hearing policy and guidance. 



Read More

Pharmacy Coverage Updates Effective October 15, 2021



Read More

211 will be available to Oregonians for help with heat-related resources, including locating a cooling center. All Oregon counties have been asked to send cooling center information to 211 for inclusion on the website, which is available in seven languages: https://www.211info.org/coolingcenters. Here is a list of additional resources for you and

Read More


This box is used to report the onset of acute symptoms for a current illness or condition or that the services are related to the patient’s pregnancy.  There are two valid qualifiers for this box, these qualifiers and their guidelines are listed below.



Read More

Effective 8/2/2021, MRI prior authorization requirements will be removed. Please see the below MRI CPT codes that will not require a prior authorization.

Read More

Effective 8/2/2021, prior authorization requirements will be removed. Please see the below CPT codes that will not require a prior authorization.

Read More

Effective 8/2/2021, prior authorization requirements will be removed for PT/OT/ST and Alternative Services. As a reminder, prior authorizations are always required for out-of-network providers.



Read More

Effective 8/1/2021, Board Registered Interns will be required to bill PacificSource Community Solutions under their own name, NPI and Medicaid ID. Previously, these practitioners were required to bill under their supervisor as incident to.

This applies to: a) Psychologist Associate Residents as described in OAR 858-010-0037; (b) Licensed Psychologist Associate under continued supervision as described in OAR 858-010-0038; (c) Licensed Professional Counselor intern or Marriage and Fam

Read More


On  May 5, 2021 date we released the below notice. At this point in time 6/25/21, the below guidance is incorrect and prior requirements will remain unchanged until further notice . We apologize for any inconvenience this has caused.

Should you have any claims impacted betweens dates of service 6/6/21 - 6/25/21, please contact your Provider Service Representative.

 

Effective 6/6/2021, prior authorization requirements will be removed for the follo

Read More


Dear Providers,

On behalf of the Oregon Health Authority, we include the below link to the Model Standing Order and Immunization Protocol for COVID-19 vaccinations. Please visit the link for details regarding important updates.

https://www.oregon.gov/oha/PH/PREVENTIONWELLNESS/VACCINESIMMUNIZATION

Read More


Board Registered Interns will be required to bill PacificSource Community Solutions under their own name, NPI and Medicaid ID, effective 8/1/2021. Previously, these practitioners were required to bill under their supervisor as incident to.



Read More

Updated Prior Authorization (PA) requirement for code 81479

Read More

Behavioral Health services – Removal of Prior Authorization requirements and related submission changes



Read More

Pharmacy Coverage Updates Effective July 15, 2021



Read More

AIM Specialty Health portal user guide

Read More

Effective 6/1/2021 a PA will be required on the following DME codes:
L3900, L3901, L3904, L3905 and A7020.
 


Read More

Effective 1/1/21 prior authorization is not be required for transfers to skilled nursing facilities, inpatient rehabilitation centers, and long term acute care hospitals. However, we do require inpatient notification as our Health Services team is performing concurrent review and will require updated notes for continued stay

Read More

On behalf of OHSU please see the below links for additional resources around the Oregon Psychiatric Access Line (OPAL). This program is offering psychiatric telephone consultations to health care providers in Oregon.   


Read More

Primary Care Provider Capacity and Member Panel Changes an Reporting Requirement  Reminders 

Read More

Medicaid Preauthorization (PA) requirements change for Cardiovascular Monitors 

Effective 5/20/2021, PacificSource will not be requiring a PA with the associated codes:

  • 93229 Wearable Mobile Cardiovascular Telemetry with Events Transmitted To Center for up to  30 Days; Technical Support
  • 93228 Wearable Mobile Cardiovascular Telemetry with Events Transmitted To Center for up to 30 Days; Physician Review W Report

 



Read More

According to a OHA CCO Contract change in 2021 a prior authorization will be required for ECT treatment effective May 23, 2021.  This contract change applies to CPT code 90870.



Read More

For dates of service on or after March 15, 2021, PacificSource Health Plans will utilize GPCI adjusted rates to determine allowables for COVID vaccine administration.

Read More

Medicaid Genetic Testing Prior Authorization Requests

Read More

Please see Oregon Health Authorities (OHA) billing guidance on COVID-19 Vaccines.

https://www.oregon.gov/oha/HSD/OHP/Tools/OHP-Vaccine-Fact-Sheet.pdf

Please Note: Providers not contracted with the CCO should bill OHA (COVID-19 Vaccines), see link for full details.



Read More

Pharmacy Coverage Updates Effective May 15, 2021



Read More

Corrections need to be made to the primary claim as these claims are crossed over.  If you correct the Medicaid claim only and the services are covered by Medicare or Commercial, this claim will erroneously create a new Medicare or Commercial claim for processing. 

Claims are crossed over from PacificSource Medicare and PacificSource Commercial to PacificSource Community Solutions for Coordination of Benefits.



Read More

In order to better align with the Oregon Health Authority, effective February 1, 2021  Pacificsource Community Solutions will now allow retro pre-approval requests for up to 90 days from the date of service.

Pre-approvals may be given a past date of service if:

  • The member was made retroactively eligible or was retroactively disenrolled from a CCO or PHP on the date of service.

  • The provider has not already billed for the service and/o

    Read More


Dear Provider’s

 

Our NEMT brokerage ModivCare formally known as LogistiCare is operating under Inclement Weather Conditions in some areas of Oregon.

 

Please know that they are prioritizing those appointments that are considered critical care – e.g. dialysis, chemo, radiation therapy, etc. In addition they are also working to reroute those and/or reschedule others that are non-critical care.

 



Read More

In April of 2018, PacificSource implementing a new process for claims research requests from providers. That pertain to all Medicare and Medicaid claim requests.

Formerly, a provider could reach out to the Provider Service Representative and request a correction or review of a claim discrepancy.

The process that was implement created a uniform approach for providers requiring all requests be sent to the claim research mailbox at: 



Read More

Dear Providers,

PacificSource Community Solutions (PSCS) no longer requires referrals for Medicaid members to see a specialist effective 1/1/2021. We have created a quick reference FAQ for our providers to help with the transition.



Read More

Effective February 25, 2021, the following code will require a Prior Authorization. 

  • 64568 Incision for Implantation of Cranial Nerve (Eg, Vagus Nerve) Neurostimulator Electrode Array and Pulse Generator.

Please call PacificSource with any questions regarding this change. 



Read More

PacificSource COVID-19 Benefit and Reimbursement FAQ - Updated January 2021



Read More

PacificSource Health Plans is dedicated to meeting the needs of our members, including the ability to locate appropriate care. Toward this goal, we are pleased to introduce a new partnership regarding provider data validation to better our Provider Directory. This partnership with BetterDoctor was effective January 2021.



Read More

Effective January 1, 2021 the following codes have been removed from our Prior Authorization grid.  Every year prior authorization requirements are subject to change; some codes are added while others are removed. Please see our Prior Authorization grid to confirm whether a service requires a prior authorization. 

  • 58660-Laparoscopy, Surgical; W/Lysis, Adhesions (Salpingolysis/Ovariolysis) (Sep

    Read More

PacificSource does not require the vaccine CPT to be billed, as the vaccines are supplied by the government. 



Read More

Effective 1/1/2021 , Intensive In Home Behavioral Health Treatment (IIBHT) CPT H0023 will require a Prior Authorization and is reserved for IIBHT services.

Read More

Dear Providers,

PacificSource is responsible for meeting standards for multiple federal and state regulations as well as accrediting standards and fulfilling obligations of contracts with various groups. As a contracted entity of PacificSource, you are also responsible for complying with these requirements and must ensure your contracted entities comply with applicable laws and regulations. . If you currently utilize or plan to work with an offshore subcontractor that uses member pr

Read More


All Community Solutions (Medicaid) claims with 2021 dates of service are being held while we validate correct pricing and benefit configuration.  We anticipate these claims will be released by January 25, 2021. 



Read More

PacificSource Community Solutions no longer requires referrals

Read More

Effective 1/1/2021 PacificSource will be removing inpatient notification requirements for maternity stays for Commercial and Medicaid plans.

Read More

COVID-19 Tool kit now includes essential information related to the vaccine

Read More

The Oregon Health Authority has updated its Oregon Medicaid provider enrollment requirements to include an additional form called "Provider Enrollment Agreement." The following Provider Enrollment Agreement will take effect with OHA starting January 1st. Any applications received December 14th and after, we ask that we collect the Provider Enrollment Agreement to help with a seamless transition into the new year.



Read More

Pharmacy Coverage Updates Effective February 15, 2021



Read More

Effective January 1, 2021 PacificSource will be implementing additional industry standard rejections that will occur at our front door once they pass through the Clearinghouse. This is an effort to help improve and ensure timely and accurate claims processing.

Read More

Expand your knowledge in tele-mental health services

Designed for providers and clinicians across the spectrum of behavioral health, this workshop series provides step-by-step instructions on setting up a tele-mental health practice with insights on best practices for client care, administration, and ethics in virtual care. Plus, get answers to your questions about developing a comprehensive tele-mental health practice.



Read More

We will be updating our prior authorization list effective for dates of service on or after January 1, 2021. Please review the summary of these changes below.



Read More

Pharmacy Coverage Updates Effective 01/01/2021

Read More

Medical Drug Formulary Change Effective 1/1/2021

Read More

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) is a highly rated, evidence-based therapy designed to treat children ages 3-17 with an array of trauma histories, including children with multiple and complex traumas in their lives.



Read More