Referring for Pain Management Services

7/30/2015 2:18:37 PM

PacificSource Community Solutions has modified the process regarding referrals for Pain Management services. 

Previously, we allowed four visits to a variety of specialists to address pain management without review or considering whether the patient’s diagnosis is covered under the Oregon Health Plan (OHP). Effective July 27, 2015, we no longer automatically approve pain management visits without review.

The new process is as follows:

  1. A referral should be made from the member’s PCP to PacificSource (via InTouch) requesting one visit to the pain specialist.
  2. The visit will be approved regardless of submitted code to allow for establishment of the diagnosis.
  3. If additional visits are needed, the specialist may request an exception via our preapproval process.

We have made this change because we are unable to show significant benefit of the previous process to our members and we are striving for greater alignment with our provider partners, who do not allow for these visits.

Please refer to this FAQ for more information.

If you have any questions regarding the above change, please contact your Provider Service Representative.


Back