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Provider Notices

Retro Pre-Approvals

2/25/2021 4:22:06 PM

In order to better align with the Oregon Health Authority, effective February 1, 2021  Pacificsource Community Solutions will now allow retro pre-approval requests for up to 90 days from the date of service.

Pre-approvals may be given a past date of service if:

  • The member was made retroactively eligible or was retroactively disenrolled from a CCO or PHP on the date of service.

  • The provider has not already billed for the service and/or received a denial citing lack of authorization as the reason. In this case, the provider may submit an appeal for reconsideration

  • The services provided meet all other criteria and Oregon Administrative Rules.

PacificSource continues to encourage best practices and submission of pre-approval requests prior to services rendered.