Latest Notices and Updates
If you have questions about any of the information on this page, you're welcome to contact your Provider Service Representative or call (855) 896-5208.
NDC Codes Required for Drug Claims Starting February 1
Effective February 1, 2017, we will require National Drug Code (NDC) numbers on all drug-related HCPC/CPT codes, including unlisted drug codes. Please see our NDC FAQ for details.
Are Your Claim CPT Codes Up to Date?
Please double check your claim CPT codes to make sure they are current. Beginning January 1, 2017, claims with termed CPT codes will be denied. Note that there is no longer a grace period.
Commercial Medical Claims Require National Drug Code (NDC) Information
As of October 31, 2016, all medical claims submitted to PacificSource Health Plans will require complete, valid National Drug Code (NDC) information. If your claim does not have the correct NDC information, we will not be able to process it and it will be returned. If you submitted the claim electronically, it will be returned to the clearinghouse. If you submitted it by mail, it will be returned to you.
If a claim has been rejected because of missing or incorrect NDC information, please resubmit the claim with the corrected NDC information.
Background: The Deficit Reduction Act of 2005 includes provisions about the state collection of data for the purpose of collecting Medicaid drug rebates from drug manufacturers for physician-administered drugs. Since there are often several NDCs linked to a single HCPCS code, the Centers for Medicare & Medicaid Services (CMS) considers the use of NDC numbers to be critical.
If you have any questions about National Drug Code information, please feel free to contact your Provider Service Representative.
Change to Flu Vaccination Coverage
Based on findings from the Centers for Disease Control and Prevention (CDC), PacificSource will not cover the FluMist effective September 1, 2016. Claims billed on or after September 1, 2016, for 90672 will deny as non-covered. This applies to all lines of business: PacificSource Health Plans (commercial), PacificSource Medicare, and PacificSource Community Solutions (Medicaid).
The Advisory Committee on Immunization Practices (ACIP) of the CDC determined nasal spray flu vaccine containing live attenuated influenza virus (LAIV) should not be used during the 2016-2017 flu season. However, the ACIP continues to recommend annual flu vaccination with either inactivated influenza vaccine or recombinant influenza vaccine for everyone age six months and older.
To view the CDC’s announcement and findings, please visit their website at: CDC.gov/media/releases/2016/s0622-laiv-flu.html
Read the Fall Issue of the Provider Bulletin
The Fall issue of our Provider Bulletin is now available. We’re pleased to announce that, once again, we have been recognized by The American Heart Association (AHA) as a Platinum-Level Fit-Friendly Worksite. In addition, we're excited the Oregon Academy of Family Physicians (OAFP) has named Dr. Kristen Dillon, MD the 2016 Oregon Family Doctor of the Year. Read these announcements, as well as DME Fee Schedule change reminder, discounted 2017 code books, PCP names removed from commercial ID cards, new Oregon CCO incentive measure: cigarette smoking prevalence, and more!
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Hospital Inpatient Notification
Please notify us within 24 hours (or by the next business day if the member is admitting during the weekend). If we don’t receive notification within 48 hours (two business days), the claim for the service will be denied and become the responsibility of the provider. Eligibility and benefits may be confirmed by contacting Customer Service, and the admission should be reported to our Health Services Department. Once notified, Health Services will provide a patient-specific, searchable reference number to the facility. This number is the facility’s confirmation that we have recorded the patient’s admission and that a PacificSource Nurse Case Manager will monitor and manage the patient’s hospitalization.
Noninvasive prenatal testing (NIPT) of cell-free fetal DNA (cfDNA)
PacificSource is committed to following evidence-based guidelines and practices for noninvasive prenatal testing of cell-free fetal DNA. Read a letter about our commercial policies (PDF).
Durable Medical Equipment Update
Effective June 1, 2016, the Durable Medical Equipment reimbursement in your contract will reference the 2016 Centers for Medicare & Medicaid Services DMEPOS Fee Schedule. This change, as allowed by your contract, will bring your payment in line with Centers for Medicare & Medicaid Services pricing. This update will affect you unless you have an extended term or other special language tying payment to a specific fee schedule. Please contact your Provider Service Representative if you have any questions.
2016 CMS DMEPOS Fee Schedule
01/12/16 - Centers for Medicare & Medicaid Services (CMS) significantly changed the reimbursement for Durable Medical Equipment, Prosthetic and Orthotics (DMEPOS), effective January 1, 2016. Changes include application of Competitive Bidding Program rates and rural and nonrural differential based on Zip code.
PacificSource provider contracts reference the CMS DMEPOS Fee Schedule for these services and products. Due to the complexity and timing of the release of the 2016 fee schedule, PacificSource will continue to reimburse for these services at the October 2015 CMS DMEPOS Fee Schedule for the state referenced in the provider contract until further notice. We will continue to assess the changes and communicate by notice or amendment as appropriate.
PacificSource and Legacy Health – A Partnership to Build a Healthier Future for Northwest Communities
10/26/15 - We’re proud to announce that PacificSource Health Plans and Legacy Health are pursuing a partnership to bring together complementary capabilities. Our shared vision of healthcare focuses on improving the experience of care, reducing healthcare costs, and improving the health of our communities.
Ultimately, this partnership was driven by both organizations’ commitment to serve both members and patients.
Important Things to Know about this Partnership
- We will maintain all our provider partnerships. We will continue to work with all our existing provider partners throughout Oregon, Idaho, and Montana. We will also continue to pursue future relationships with other healthcare providers.
- No change to existing provider contracts, processes, policies, programs, or staff. Please be assured that our processes, such as preauthorization and claims payment, will continue as usual. In addition, our name and brand will remain the same.
- For members, nothing has changed. Members will continue to receive the same outstanding benefits and unmatched customer service that have been hallmarks of PacificSource since 1933.
- As we move forward, the partnership will provide the foundation for improvements and enhancements. This includes increased access to care for communities, the creation of new and unique health plan offerings, and industry-leading stability in a volatile health insurance market.
Looking for more information? You’re welcome to read the news release or our FAQ for providers to learn more about Legacy Health and this partnership.
Questions about the Affordable Care Act? You'll find information, FAQs, and links to online resource in our Healthcare Reform Resource Center.