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.