Provider Notices


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

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Lane, Marion, Polk, Gorge and Central Oregon CCOs expected to be awarded

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One Key Question® certified training opportunity

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Behavioral Health InPatient Notification

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Non-Covered Medicare Service

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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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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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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

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

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AIM Genetic Testing Program Webinar

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AIM Genetic Testing Prior Authorization Change Effective July 1, 2019

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Pharmacy Coverage Updates Effective June 15, 2019



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Pharmacy Coverage Updates Effective June 17, 2019 

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



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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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 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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Notice on behalf of the Oregon Health Authority (OHA)

 

In December, OHA announced



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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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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

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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



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

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Pharmacy Coverage Updates Effective April 15, 2019

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


Duplicate 1099 Forms

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Lactation Services - Referral Requirement removed for Medicaid

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



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Donated Breast Milk Benefit Implementation

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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

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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

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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

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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 

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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

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



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Pharmacy Coverage Updates Effective October 15, 2018

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Pharmacy Coverage Updates Effective September 17, 2018

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Injection Codes - Removal of Preapproval Requirement

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This post contains information regarding the Inpatient Stay review format.

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Medical Nutrition Therapy referral requirement



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