Starting July 1, 2022, people who are 19-25 or 55 and older may be eligible for full Oregon Health Plan (OHP) and other
medical assistance benefits regardless of their immigration status. This is possible because of HB 3352 (2021) which put
into law a program called “Cover All People.” The program is now known as “Healthier Oregon.”
To learn more about this program, visit Oregon.gov/HealthierOregon or Oregon.gov/OregonMasSaludable for the Spanish
PacificSource has been made aware of a phone scam claiming to be the Oregon Medical Board, asking for personal information. The Oregon Medical Board has released an official notice on these scams. Please be digilent and don't provide the caller any personal information. See the Oregon Medical Board official alert here:
Prior Authorization Requirement Removed for CPT 97129 - Effective 4/15/22
Pharmacy Coverage for 90-day Medications
On 3/25/2022, a notice was posted stating that Oregon Health Authority (OHA) made the determination that POS 10 for telehealth will no longer be recognized for Medicaid claims. OHA has now clarified that CCO's have the option to accept POS 10 if they choose.
PacificSource Community Solutions has made the determination to accept POS 10 for telehealth claims.
Please reach out to your Provider Service Representative with any questions.
Pharmacy Coverage Updates Effective March 15, 2022
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).This report now identifies member language and interpreter needs, including Sign Language needs. For more information on our Community Solutions approved Interpreter Vendors, see our Read More
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.
Please reach out to Health Services at Read More
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
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