Provider Relief Plan

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Providers’ COVID-19 Benefit and Reimbursement Policy Frequently Asked Questions (FAQs)

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Pharmacy Coverage Updates April 15, 2020 and June 15, 2020

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On behalf of OHA we are sharing this information to keep our providers informed and current with any changes made. This Information is specific to Oregon Health Plan physical and behavioral health providers.

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COVID-19 Emergency Declaration Health Care Providers Fact Sheet

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COVID-19 Action Plan and Coding Guidance

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The PacificSource Credentialing team has recently updated our policy on the Medicaid Validation application process.

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Billing Dual Covered Members -  PacificSource Medicare Advantage and Community Solutions

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LogistiCare Solutions - Effective date April 1, 2020

 

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PacificSource is proactive in moving claims electronically, and we encourage providers to consider electronic billing opportunities.

Some of the benefits providers can realize by transmitting claims electronically are:

• Faster reimbursement. By eliminating the time it takes for mailing, internal routing, and data entry, claims are in our system much faster, and are in line for payment sooner.

• Reduced costs. Electronic billing saves pr
  
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Effective 2/17/2020 - New Prior Authorization Requirements for Neurophyscological Exam and Testing

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Pharmacy Coverage Updates March 15, 2020

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Oregon Health Plan (OHP) Members receive dental benefits through Dental Care Organizations (DCOs). All OHP Members have dental benefits. PacificSource CCO Members receive dental benefits through the following DCO partners in all PacificSource regions:

• Advantage Dental

• Capitol Dental Care

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Auth Grid and Clinical Criteria

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For questions regarding participation status please contact our Customer Service teams or your Provider Service Representative.

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We have received an influx number of member calls to our Provider Service phone queue. In an effort to best help our members’ please refer them to our Customer Service Department, as we strive to provide first call resolution for our members.

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For PacificSource Community Solutions Advanced Imaging Prior Authorizations need to be submitted via our Provider Portal (InTouch). All Genetic Testing Prior Authorizations effective July 1, 2019 are submitted to AIM.

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Medicaid Member PCP and DCO assignment for the new CCO areas for Lane, Marion and Polk Counties is in progress. Providers needing to submit new Prior Authorizations within our Provider Portal (InTouch) we are advising to wait until 1/6/20.

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For Dates of Service 2.2.2020 and after OHA requires that providers bill out of hospital delivery/births to the state directly.

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Medicaid Members showing assigned in error to Kaiser has been resolved.

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Medicaid Member PCP and DCO assignment for new CCO areas for Marion, Polk, and Lane Counties is in progress.  In addition, some members are showing as assigned to Kaiser in error.  DCO Assignment is also still in progress.  Thank you for your patience while we get this issue resolved. 

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PacificSource Community Solutions is happy to announce our Health Care Interpreter (HCI) partners effective 1/1/20.

 

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We are wanting to ensure our providers are updated regarding our Medicaid members starting with PacificSource Community Solutions with an effective date of 1/1/20 for Lane, Marion and Polk.

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We are no longer including members assigned Primary Care Provider (PCP) on our Member ID cards.

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Pharmacy Coverage Updates Effective January 15, 2020

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2020 Non-Emergent Medical Transportation by CCO Region

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Change in Provider Contract Effective Dates - Effective January 1, 2020

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PacificSource Community Solutions invites our provider partners to participate in our upcoming provider training. The focus will be about the PS BHI clinical model and requirements for reimbursement, including self-attestation, site reviews and reporting requirements for receiving a PMPM when fidelity standards of BHI are met.

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PacificSource Community Solutions invites our provider partners to participate in our upcoming provider training. The focus will be around onboarding our providers to ensure providers can best serve our Medicaid members. These webinars will take place over the phone and online. This will allow for providers and/or staff to attend from the convenience of their offices.

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Pharmacy coverage changes

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PacificSource Community Solutions (PSCS) is requesting proposals to convene and facilitate a System of Care governance structure to provide oversight for Wrap Around services in Marion County and Polk County.

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Pharmacy Coverage Updates Effective December 15, 2019

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PacificSource Community Solutions (PSCS) is requesting proposals to convene and facilitate a System of Care governance structure to provide oversight for Wrap Around services in Wasco County and Hood River County.  

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Vaccines For Children - Modifier SL

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Pharmacy Coverage Updates Effective October 1, 2019 

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Effective October 1, 2019 Centers for Medicare and Medicaid Services (CMS) will put into effect a new classification for Skilled Nursing Facilities (SNF).

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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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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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