We recommend all Claim Status checks be completed using our secure provider portal, InTouch for Providers. Please visit OneHealthPort.com to sign up or log in.
For claims status unable to be obtained via InTouch for Providers, please complete the Claims Status Request form and email it SECURELY to the emails outlined below, based on line of business.
Pharmacy Coverage Updates Effective October 15, 2022
Effective August 29, 2022 pre authorization is required for codes 96116, 96121, 96132, 96133, 96136, 96137, and 96146
Dear Behavioral Health Providers,
We want first to thank you for your continued care of our members. We have received several questions from our Behavioral Health provider partners requesting more information regarding the Public Note that the Oregon Health Authority released regarding the plan to increase the Behavioral Health and SUD fee schedule.
OHA distributed a news release on June 15th indicating that new rules made by the state Legislature’s passage of HB 2359 during the 2021 session related to use of qualified or certified health care interpreters will be implemented as of July 1, 2022. The new rules require publicly reimbursed health care providers to work with a qualified or certified health care interpreter who is listed on OHA’s registry and also outlines record keeping requirements for health care providers and
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