Provider Notices

Pharmacy Coverage Updates Effective November 15, 2020

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At this time we encourage our providers to reach out to our Provider Service team when faced with challenges.

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The THW Liaison team is available to support the integration and utilization of THWs (birth doulas, personal health navigators, peer support specialists, youth support specialists, family support specialists, peer wellness specialists and community health workers). Working in partnership with the Provider Services team, the Liaisons can assist THWs with Oregon Health Authority (OHA) approved training, OHA THW certification, best practices and other technical assistance.

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Pharmacy Coverage Updates Effective October 15, 2020

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On behalf of OHA- COVID-19 Funding Opportunity for Community Based Organizations, Recovery Support Programs, and Peer-Run Organizations

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On behalf of OHA- OHA Provider Matters- Updates and resources for providers

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We have noticed an increased number of providers submitting duplicate claims days apart from each other.  This duplicate volume significantly impacts the workflow resulting in delays.

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OneHealthPort New Requirement for Multi-Factor Authentication (MFA) Effective 8/11/2020

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Pharmacy Coverage Updates Effective 09/15/2020

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Pharmacy Coverage Updates Effective August 15, 2020

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835 PLB Segment Enhanced To Include Patient Account Number Effective 8/16/2020

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COVID-19 FAQ for Providers: Reimbursement, Telehealth, and More - Updated July 27, 2020

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Effective July 1, 2020 Prior Authorization (PA) requirements are being set on dental codes 41899 Unlisted Proc, Dentoalveolar Structures and 00170 Anesthesia, Intraoral Proc, W/Bx; Nos.  A PA will need to be submitted along with the DCO approval letter. Without a PA and DCO approval letter the request will be subject to a denial. Please call PacificSource Community Solutions if you have any questions.

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PacificSource Community Solutions is implementing process changes for non-emergent ambulance transportation rides and how they should be requested and provided to our members, in each of our CCO regions.

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On behalf of OHA we are sharing this information.

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Updates to AIM Advanced Imaging Clinical Appropriateness Guideline

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Medicaid Provider Stability Payments

 

In collaboration with the Oregon Health Authority, PacificSource is in the process of issuing provider stability payments to support providers who serve our CCO members and who rely on fee-for-service payments from PacificSource. This is intended to offset financial impacts on providers due to the COVID-19 pandemic.

 

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PacificSource Community Solutions is working to support our members and communities during this pandemic. We have implemented the following to support providers in this time of uncertainty:

• Eased operational burdens on providers

• Expanded telehealth billing policies

• Distributed early payments under 2019 risk arrangements

• Distributed 2019 quality incentive “early release” funds made available by
  
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Pre-Approval requirement for Repetitive Transcranial Magnetic Stimulation (rTMS)

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Medicaid Therapy FAQ

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On behalf of OHA we are sharing this information.

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Free Online Disaster Behavioral Health Training for Health Care Professionals & First Responders

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On behalf of OHA we are sharing this link that includes detailed information to keep our providers informed and current with any changes made. 

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Medicaid PA Removals for “S” codes, IV Home Infusions and Intravitreal injections.

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Provider Relief Plan

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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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