Provider Notices


New Medicaid Provider Validation Process

5/28/2019 10:54:46 AM

Dear Providers,

PacificSource has recently implemented a new validation/oversight process for Medicaid eligible practitioners who do not qualify for full credentialing. These provider types include, but are not limited to, traditional health workers, addiction counselors, qualified mental health professionals/associates, and providers who are licensed but practice under supervision (ie. Psychologist Resident, Licensed Professional Counselor Intern, etc).

This new process was implemented due to an Oregon Health Authority (OHA) requirement to have oversight of our providers that we pay claims for, but that do not undergo full credentialing. This process allows us to properly vet our providers and verify that they meet all requirements for participation; it also allows us to have ongoing oversight to ensure quality of care to our members. Similar to the credentialing process, validation is required for all providers prior to participation, and these providers must complete a revalidation process at least every three years.

The Credentialing team will be reviewing and reconciling group rosters that are submitted to ensure that all providers have undergone either full credentialing or validation, based on their provider type.

Please send your group rosters to ProvNetSupport@pacificsource.com and Credentialing@pacificsource.com at least once per quarter, so that we can ensure that all providers are credentialed, validated, and/or loaded into our claims payment system. For your convenience, the roster template (linked below) that our Operations team uses to reconcile the claims system is attached to this email. If you prefer, you may send us your group roster in your own format.

If you have questions about the Medicaid provider validation process that are not addressed in the FAQ (linked below), please contact our Credentialing team directly at Credentialing@pacificsource.com or by phone at (541) 225-3747.

Thank you for your continued partnership in ensuring patient safety!


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