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Provider Notices

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.



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Pharmacy Coverage Updates Effective October 15, 2022



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Durable Medical Equipment Prior Authorization Requirements Effective 10/1/22

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There is a delay in August Capitation payment reporting.  We will provide an update with estimated resolution date as soon as we have additional information. 

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Effective August 29, 2022 pre authorization is required for codes 96116, 96121, 96132, 96133, 96136, 96137, and 96146



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SPH Analytics Calls

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Prior Authorization requirement on CPT 97010 - Effective 8/19/22

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Please see below notice from Modivcare, who is experiencing technical difficulties.  (Now Resolved)

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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.


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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

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Three-Dimensional (3D) Printed Orthopedic Implants

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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
versi

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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:

https://www.oregon.gov/omb/Topics-of-Interest/Pages/DEA-Impersonator-

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Prior Authorization Requirement Removed for CPT 97129 - Effective 4/15/22

 



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Pharmacy Coverage for 90-day Medications



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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. 



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Effective 04/25/2022, A prior authorization requirement will be added to code 58571 Laparoscopy, Surgical, with Total Hysterectomy, for Uterus 250g or Less; with Removal of Tube(s) and/or Ovary(s) 

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Telehealth Place of Service Code 10 - Effective Immediately

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There was unfortunately an unforseen technical challenge delaying the roll out of the AIM Radiology Program. We estimate this to be resolved 4/3/2022.  Please continue to use InTouch for Providers to submit all Medicaid Diagnostic Imaging Prior Authorizations until this situation is resolved.  As always, please refer to our Prior Authorization Grid and Line Finder Tools, and let your Provider Service team know if there are any questions.  

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Access To Care Survey is now conducted by phone

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The AIM portal for Diagnostic Imaging PA's will open on 3/21/2022

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We are unable to accept Prior Authorization requests via email.  Please submit all Prior Authorizations via our Secure Provider portal, InTouch. If you have any questions or concerns, please reach out to your Provider Service Rep, or email ORProviderService@pacificsource.com.

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Correction to prior notice- Effective 1/1/2022, prior authorization requirements will remain on Neuropsychological codes.  A prior authorization requirement will be added to code 96137 Psych or neuropsych test, addl.

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Effective 4/1/2022, PacificSource will transition the review of all outpatient diagnostic imaging services for PacificSource Community Solutions (PCS) members to AIM Specialty Health.

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OHA has recently updated the fee-for-service payment rates, and also included a new enhanced wage add-on rate for approved nursing facilities effective 10/1/2021. Those who qualify will be notified and have a specialty code added to the facility’s Oregon Medicaid provider number that allows billing for the enhanced rate. Read the full OHA notice here https://www.oregon.gov/oha/HSD/OHP/Announcements/Hospice-Rates1

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Pharmacy Coverage Updates Effective March 15, 2022



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PacificSource Community Solutions Claims Pay Hold  

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



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Pharmacy Coverage Updates Effective January 1, 2022



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Effective 1/1/2022, prior authorization requirements will remain on Neuropsychological codes.  A prior authorization requirement will be added to code 93137 Psych or neuropsych test, addl. 

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

 



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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

Philips CPAP/BiPAP Recall Information

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



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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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2022 Medicaid Authorization Grid Updates - Effectve 1/1/2022

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