Effective for dates of service on or after January 1, 2022, prior authorization requirements will be changing. Please visit the Auth Grid to see changes to specific procedures, therapies and durable medical equipment. Below are some of these updates.
PA requirements will be removed on the following services:
Durable Medical Equipment < $1000
PA requirements will be added to the following codes based on the limitations noted:
PT/OT/ST if > 40 total visits per calendar year
Alternative care if > 20 total visits per calendar year
Providers are expected to check member's eligibility and benefits prior to rendering care. To determine if your patient’s condition is covered by OHP, please check LineFinder by clicking here. A quote of benefits and/or authorization does not guarantee payment or verify eligibility. Payment of benefits is subject to all terms, conditions, limitations, and exclusions of the member’s contract at the time of service.
Prior authorizations are always required for out-of-network providers.
If you have questions regarding these changes, please contact your PacificSource Provider Services Representative.