Our office-space closures help ensure community and employee safety
In our effort to slow the spread of COVID-19, PacificSource office locations remain closed. Until further notice, we’re unable to accommodate any walk-in visitors. As always, our Customer Service team is glad to answer your questions by phone or email. Let us know how we can help!
Contact Us

Provider Notices

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

We acknowledge the requests from our Behavioral Health provider communities who wish to continue to serve our members via Telehealth only visits post emergency declaration. We are currently evaluating at this time, and are looking to recent and expected state and federal guidance as we determine how best to meet the needs of providers and our members. We will be communicating to our provider communities once we have made a determination.

Read More

Pharmacy Coverage Updates Effective December 15, 2020



Read More

Delayed Payments and Explanation of Payments

Read More

Pharmacy Coverage Updates Effective November 15, 2020



Read More

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

Read More

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.



Read More

Pharmacy Coverage Updates Effective October 15, 2020

Read More

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

Read More

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

Read More

 

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.



Read More

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

Read More

Pharmacy Coverage Updates Effective 09/15/2020



Read More

Pharmacy Coverage Updates Effective August 15, 2020

Read More

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

Read More

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

Read More

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.

Read More

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.

Read More

On behalf of OHA we are sharing this information.

Read More

Updates to AIM Advanced Imaging Clinical Appropriateness Guideline



Read More

 

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.

 



Read More

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

    Read More


Pre-Approval requirement for Repetitive Transcranial Magnetic Stimulation (rTMS)

Read More

Medicaid Therapy FAQ

Read More

On behalf of OHA we are sharing this information.

Read More

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

Read More

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

Read More

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

Read More

Provider Relief Plan



Read More

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

Read More

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.



Read More

COVID-19 Emergency Declaration Health Care Providers Fact Sheet



Read More

COVID-19 Action Plan and Coding Guidance

Read More

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

Read More

Billing Dual Covered Members -  PacificSource Medicare Advantage and Community Solutions



Read More