Provider Pre-approval Grid

Welcome to our online Pre-approval Grid. The following grids allow you to identify procedures or services that require pre-approval from PacificSource Community Solutions.

As noted, the Grid does NOT identify whether procedures or services are or aren't covered. For determination of coverage, please contact our Customer Service team or visit the resources under the LineFinder page:

For information about how our clinical decision-making process, resources and oversight please see:
PacificSource Clinical Decision Resources

Printable Grids