PacificSource Community Solutions, PacificSource Medicare, and PacificSource Health Plans supports the use of practice guidelines that are based on nationally recognized, valid, and reliable evidence-based clinical literature or a consensus of professionals in a particular field. PacificSource adopts medical and behavioral health guidelines to assist providers and members in making decisions about appropriate healthcare choices. PacificSource practice guidelines are not meant to replace the clinical judgment of a treating provider. Guidelines are reviewed and updated as needed on an annual basis.
In all cases, benefit determinations should be based on the applicable contract coverage. Should there be any discrepancy between these guidelines and the contract language, the contract language will take precedence.