Pharmacy Coverage Updates Effective November 15, 2020
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.
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.
Pharmacy Coverage Updates Effective 09/15/2020
Updates to AIM Advanced Imaging Clinical Appropriateness Guideline
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.
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
Provider Relief Plan
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.
COVID-19 Emergency Declaration Health Care Providers Fact Sheet
Billing Dual Covered Members - PacificSource Medicare Advantage and Community Solutions
LogistiCare Solutions - Effective date April 1, 2020
PacificSource is proactive in moving claims electronically, and we encourage providers to consider electronic billing opportunities.
Some of the benefits providers can realize by transmitting claims electronically are:
Faster reimbursement. By eliminating the time it takes for mailing, internal routing, and data entry, claims are in our system much faster, and are in line for payment sooner.
Reduced costs. Electronic billing saves pr
Oregon Health Plan (OHP) Members receive dental benefits through Dental Care Organizations (DCOs). All OHP Members have dental benefits. PacificSource CCO Members receive dental benefits through the following DCO partners in all PacificSource regions:
Capitol Dental Care
For questions regarding participation status please contact our Customer Service teams or your Provider Service Representative.
Medicaid Member PCP and DCO assignment for the new CCO areas for Lane, Marion and Polk Counties is in progress. Providers needing to submit new Prior Authorizations within our Provider Portal (InTouch) we are advising to wait until 1/6/20.
Medicaid Members showing assigned in error to Kaiser has been resolved.
PacificSource Community Solutions is happy to announce our Health Care Interpreter (HCI) partners effective 1/1/20.
We are wanting to ensure our providers are updated regarding our Medicaid members starting with PacificSource Community Solutions with an effective date of 1/1/20 for Lane, Marion and Polk.
Pharmacy Coverage Updates Effective January 15, 2020