Provider Notices

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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Pharmacy Coverage Updates Effective June 25, 2018

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PacificSource allows “incident to” billing for caregivers who are not eligible to be credentialed by PacificSource or a delegated credentialing entity.  This provides practices the opportunity to fully utilize their staff appropriately.  PacificSource does NOT allow incident to billing for practitioners who are eligible for credentialing. 

Effective June 1, 2018, in order for a service to be considered for payment under the “incident to” billing policy, the modifier SA must be appen

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The State of Oregon has upcoming Provider Education Series.  You can find information regarding these opportunities here. Please reach out to OHA for further information

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Incontinence Supplies will require prior authorization effective 5/6/2018

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Update to Prolotherapy and Nail Debridement processes

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An update to the claim research requests through Provider Service Representatives has been made and information on this new procedure is outlined here. The new process will begin on April 2, 2018

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Pharmacy Coverage Updates Effective March 15, 2018

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Please review updated Therapy visits guidelines regarding calendar year vs. rolling year.

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New CPT and HCPC codes have been added to the Pre-Approval Grid for Medicaid services. Please find more information within this update:

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Please join us for a webinar that will answer questions regarding the upcoming HEDIS Audit

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Please find 2018 coding updates for Medicare and Medicaid within this post.

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the GT modifier will no longer be required on approved Tele Medicine procedures for 2018

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Effective 01/01/2018: oral devices preapproval required

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Pharmacy Coverage Updates Effective January 1, 2018

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Pharmacy Coverage Updates Effective December 1, 2017 

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