Effective January 1, 2024, PacificSource will begin completing utilization management reviews for members who have received 26 or more therapy/counseling visits. Behavioral health providers will be contacted and asked to submit clinical information, which will be reviewed for ongoing service.
Clinical information required will include:
- Most recent annual assessment
- Current treatment/service plan
- Five most recent treatment/service notes
The purpose of these reviews are:
- To ensure treatment is medically necessary and progress is being made toward treatment objectives/goals
- To ensure adequate access for all PacificSource members
PacificSource will be verifying resources are being used appropriately. Claims may be pended if treatment plan documents are not received within 30 days of being requested.
Note: this is applicable to non-Certificate of Approval (COA) agencies/providers only.