Provider Notices

Effective 7/1/2019 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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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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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
Lisa Millet, OHA Public Health Injury and Violence Prevention

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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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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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St Charles is hosting support groups for new mothers. More information can be found in this posting.

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