Provider Notices


Please review updated Therapy visits guidelines regarding calendar year vs. rolling year.

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New CPT and HCPC codes have been added to the Pre-Approval Grid for Medicaid services. Please find more information within this update:

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Please join us for a webinar that will answer questions regarding the upcoming HEDIS Audit

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Please find 2018 coding updates for Medicare and Medicaid within this post.

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the GT modifier will no longer be required on approved Tele Medicine procedures for 2018

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Effective 01/01/2018: oral devices preapproval required



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Pharmacy Coverage Updates Effective January 1, 2018

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Pharmacy Coverage Updates Effective December 1, 2017 

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For In-network providers, PA's will no longer be required for Home Health Care. More information can be found in this post.

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New procedure information for cataract procedure reqirements as of January 1, 2018 can be found here.



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Requirements for submitting claims with Time-Based Codes can be found here.

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Information regarding Workshop for Medical Assistants

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Pharmacy Coverage Updates Effective November 1, 2017

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New Requirement for Alternative Therapies can be found here:

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Please click on the read more link to find out detailed information on this requirement.

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The American Cancer Society is partnering with RMPHTC to launch a new interactive tool regarding colorectal screenings.  

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Information regarding this update can be found at the link within this post:

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Letters were mailed to Medicaid Providers Regarding Annual Compliance Training

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Pharmacy Network Change Effective August 1, 2017

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Pharmacy Coverage Updates Effective September 15, 2017

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PacificSource Community Solutions maintains a closed behavioral health panel for our Medicaid members in Central Oregon and the Gorge. In order to better serve our members’ needs, we are seeking additional behavioral health providers to be part of this panel. Click READ MORE for detailed information.

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There has been an update to the OHA HCPC codes as outlined in this post. Please contact PacificSource Community Solutions with any questions. Thank you!

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PacificSource has added information to the current Pain Management treatment guidelines.  

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Please review a change to the PT/OT/ST services effective June 17, 2017.

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PacificSource Community Solutions covers blood clotting factors and related items used for the administration of such factors for hemophilia patients competent to use such factors without medical supervision. Please refer to the body of this post for specific information:

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Pharmacy Coverage Updates Effective July 15, 2017

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There has been a change to the Pre-Approval process for Colonoscopy cpt codes

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An update has been made to the PacificSource Hospital Bed Coverage for Medicaid. 

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Effective May 18, 2017, CPT 98925 will require a preapproval. 



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An update to the Medicaid policy for Provider-based billing services can be found here.  Please contact your Provider Representative if you have any questions.  Thank you. 

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Pharmacy Coverage Updates Effective May 22, 2017

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Pharmacy Coverage Updates Effective May 1, 2017

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Update to the Errata codes can be found here.

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An updated smoking cessation guideline for elective surgical procedures can be found here.  Please contact your Provider Service Representative with any questions.  Thank you.

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February is Heart Health Month: Celebrate by Maintaining a Healthy Blood Pressure

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New payment guidelines have been established for Long-Acting Reversible Contraceptive Placement.  Please read the details below. 

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An upcoming provider workshop relating to Chronic Disease Management of Prediabetes. This presentation does count towards CME Credits.

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PacificSource Prior Authorization (PA) and Referral Guideline can be found here.  Please contact your Provider Service Representative if you need clarification or have any questions.

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PacificSource COB policy information can be found here. Please contact your Provider Service Representative if you need further clarification or have any questions.

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Yearly Testing and Preventive Care Best Practices

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