Effective July 1, 2019 Vision Therapy will require a prior authorization (PA). Vision therapy is covered for children through age 20, with a covered diagnosis per the Prioritized List of Health Services.
Effective 11/1/2019 PacificSource Community Solutions will start denying provider claims for providers that are billing with either their Tax-ID number or Social Security Number (SSN) if the information billed doesn’t match what the State has on file. Updates must be made through us PacificSource Community Solutions .
Pharmacy Coverage Updates Effective June 15, 2019
Effective 5/20/2019, PacificSource will not be requiring a PA with the associated codes:
Currently 43248 Upper GI Endoscopy w/insertion of Guide Wire/Dilatation requires a Prior Authorization (PA). Effective April 15, 2019 the PA requirement will be removed. This code will no longer require a PA.
Notice on behalf of the Oregon Health Authority (OHA)
In December, OHA announced
New Provider Enrollment, the State of Oregon will conduct pre-enrollment and post-enrollment site visits for high and moderate risk provider types. You can find more information regarding this new process on the below link to OHA’s website.
On the behalf of OHA, PacificSource encourages you to visit the below link. Here you will find some great resources offered by OHA, focusing on tobacco dependence treatment in a behavioral health setting.
Urine drug screening reminders for Medicaid Behavioral Health codes
The Oregon Health Authority (OHA) has postponed implementation of Read More
Changes to OHP coverage of Medication-Assisted Treatment effective 1/1/2019
On 01/01/2019, OHA’s diabetic prevention program will be in effect. PacificSource will not be requiring a PA with the associated codes effective January 18th 2019:
Change to sterilization consent requirements effective 1/1/2019
Ambulatory surgical centers can bill OHA for post-procedure long-acting reversible contraceptive placement effective 1/1/2019
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
CMS is placing a claims payment hold on all Inpatient and Long Term Care claims with discharge dates 10/1/18-10/22/18
Therapies related to Guideline Note 56 (back and spine)- Reassessment Tool required for subsequent visits
Alternative Care Visit Limits/Determination – alignment across all therapy modalities.
Medical Nutrition Therapy referral requirement