Effective January 1, 2022:
- Notification of admission for ACT will be submitted by the provider through the InTouch portal using the inpatient module indiacting the level of care "ACT" .
- Notification must be received within 2 business days of admission.
- If the member has not discharged from the program after 90 days, the provider must inform PacificSource of additional days needed.
- Providers must inform PacificSource of patients discharge and patient disposition.
- Provider denials of ACT enrollment must also be submitted as above. Denials must include provider documentation and specific OAR criteria for PacificSource to issue the Notice of Adverse Benefit Determination (NOABD). Denials must be received within 12 hours of decision for timely denial notification.
- Member refusals of admission must also be submitted within two business days to allow appropriate case management follow up with the member.
Please contact PacificSource with any questions regarding this change.