Provider Notices

Pharmacy Coverage Updates Effective March 15, 2022

Funding opportunity: Clinical Supervision Program for Behavioral Health Providers

Prior Authorization required for Transcranial Magnetic Stimulation (TMS) Effective February 1, 2022

Pharmacy Coverage Updates Effective January 1, 2022

According to an OHA CCO Contract change in 2022 providers offering ACT services will be required to submit a notification though the InTouch Portal.

We wanted to pass along an enhancement to the PCP Enrollment Listing report that is available to all PCP providers via InTouch (InTouch > Reports > PCP Enrollment Listing).

Changes to Notification Requirements for Assertive Community Treatment (ACT) Services

Effective 12/01 2021, members admitted to an Acute Inpatient Hospital where payment is based on a DRG (diagnosis related group): 

Approved initial inpatient reviews will be authorized for a DRG payment rather than a goal length of stay. This will eliminate routine concurrent reviews. After the claim is received and before payment is made, outlier payment requests will be reviewed for medical necessity.

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We have updated the below notice to reflect the updated name for ‘Board Registered Interns’ to the correct name effective August 6, 2021, to ‘Board Registered Associates’ per Oregon State Legislation.

The below notice is still current. The only change made is relative to the Oregon State Legislation, implementing the immediate name change.

Update as of August 30th 2021- RideSource also known as Lane Transit District’s (LTD) our NEMT brokerage in Lane County is operating under regular capacity. 

Medicaid Grievance and Appeals Policy Guidance

These documents contain policy guidance for Member Information and Education Requirements, Notice of Adverse Benefit Determination, Grievances Appeals and Hearing policy and guidance. 

Pharmacy Coverage Updates Effective October 15, 2021

211 will be available to Oregonians for help with heat-related resources, including locating a cooling center. All Oregon counties have been asked to send cooling center information to 211 for inclusion on the website, which is available in seven languages: https://www.211info.org/coolingcenters. Here is a list of additional resources for you and

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This box is used to report the onset of acute symptoms for a current illness or condition or that the services are related to the patient’s pregnancy.  There are two valid qualifiers for this box, these qualifiers and their guidelines are listed below.

Effective 8/2/2021, prior authorization requirements will be removed for PT/OT/ST and Alternative Services. As a reminder, prior authorizations are always required for out-of-network providers.

Effective 8/1/2021, Board Registered Interns will be required to bill PacificSource Community Solutions under their own name, NPI and Medicaid ID. Previously, these practitioners were required to bill under their supervisor as incident to.

This applies to: a) Psychologist Associate Residents as described in OAR 858-010-0037; (b) Licensed Psychologist Associate under continued supervision as described in OAR 858-010-0038; (c) Licensed Professional Counselor intern or Marriage and Fam

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