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Provider Notices

Duplicate 1099 Forms
Duplicate 1099 Forms

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Lactation Services Referral Requirement Removed Effective 2/1/19
Lactation Services - Referral Requirement removed for Medicaid

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Changes to OHP coverage of Medication-Assisted Treatment effective 1/1/2019

Changes to OHP coverage of Medication-Assisted Treatment effective 1/1/2019



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Donated Breast Milk Benefit Implementation Effective January 1, 2019
Donated Breast Milk Benefit Implementation

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Diabetes Prevention Program (DPP)

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:



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Continuous Glucose Monitors (CGM) - Coverage Update
Continuous Glucose Monitors (CGM) - Coverage Update

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Claims

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



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Gender Affirming Surgery - Preapproval Requirements - Effective December 3, 2018
Gender Affirming Surgery - Preapproval Requirements

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PacificSource Medical Drug Formulary changes, Effective on 01/01/2019

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



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PacificSource Accepting Traditional Medicare Crossover Claims
PacificSource Accepting Traditional Medicare Crossover Claims

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Holding claims for pricing based on October 2018 IPPS release

CMS is placing a claims payment hold on all Inpatient and Long Term Care claims with discharge dates 10/1/18-10/22/18



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Pharmacy Coverage Updates Effective November 19, 2018
Pharmacy Coverage Updates Effective November 19, 2018 

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Medicaid Reassessment Tool Notification

Therapies related to Guideline Note 56 (back and spine)-  Reassessment Tool required for subsequent visits



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Injection Codes Update - Removal of Preapproval Requirement
Injection Codes Update - Removal of Preapproval Requirement

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Alternative Care Visit Limits/Determination – alignment across all therapy modalities.

Alternative Care Visit Limits/Determination – alignment across all therapy modalities.



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Pharmacy Coverage Updates Effective October 15, 2018
Pharmacy Coverage Updates Effective October 15, 2018

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Pharmacy Coverage Updates Effective September 17, 2018
Pharmacy Coverage Updates Effective September 17, 2018

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Injection Codes - Removal of Preapproval Requirement
Injection Codes - Removal of Preapproval Requirement

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Inpatient Stay Update – only one IP reference number per stay
This post contains information regarding the Inpatient Stay review format.

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Medical Nutrition Therapy referral requirement

Medical Nutrition Therapy referral requirement



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New Prior Authorization Requirements for Contact Lenses- Effective 07/29/2018

New Prior Authorization Requirements for Contact Lenses - Effective 07/29/2018

 



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Free 1-hour training module with CMEs – Changing the Conversation About Pain: Pain is Everyone's Job
Free 1-hour training module with CMEs – Changing the Conversation About Pain: Pain is Everyone's Job
Lisa Millet, OHA Public Health Injury and Violence Prevention

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Record Retention Guidelines
An update has been made as of January 1, 2018, for Record Retention. More information can be found in this post.

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Holding Claims for Pricing Based on the July 2018 FISS Release
CMS is placing all IP claims (PART A) on a hold for dates of service on/after July 1, 2018 while the pricing files are being updated.  This will ensure proper payment going out.  

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Support for New Mothers in Central Oregon
St Charles is hosting support groups for new mothers. More information can be found in this posting.

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Pharmacy Coverage Updates Effective June 25, 2018
Pharmacy Coverage Updates Effective June 25, 2018

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Updated "Incident to" billing policy - Effective 6/1/18

PacificSource allows “incident to” billing for caregivers who are not eligible to be credentialed by PacificSource or a delegated credentialing entity.  This provides practices the opportunity to fully utilize their staff appropriately.  PacificSource does NOT allow incident to billing for practitioners who are eligible for credentialing. 

Effective June 1, 2018, in order for a service to be considered for payment under the “incident to” billing policy, the modifier SA must be appen

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Upcoming Provider Education Series hosted by the State of Oregon
The State of Oregon has upcoming Provider Education Series.  You can find information regarding these opportunities here. Please reach out to OHA for further information

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New Prior Authorization Requirements for Incontinence Supplies
Incontinence Supplies will require prior authorization effective 5/6/2018

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Prolotherapy and Nail Debridement
Update to Prolotherapy and Nail Debridement processes

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New Claims Research Request Process
An update to the claim research requests through Provider Service Representatives has been made and information on this new procedure is outlined here. The new process will begin on April 2, 2018

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Pharmacy Coverage Updates Effective March 15, 2018
Pharmacy Coverage Updates Effective March 15, 2018

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