News and updates
Trigger finger or thumb surgical procedure will require prior authorization effective November 1, 2023
For Medicaid plans: Effective November 1, 2023, a prior authorization will be required for CPT Code 26055 (Tendon Sheath Incision).
Pharmacy Coverage Updates Effective September 15, 2023
We would like to inform you of changes to our PacificSource Community Solutions formulary and coverage policies.
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Medicaid Grievance and Appeals policies updated
These updated documents contain policy guidance for the Medicaid Grievance and Appeals System. The changes will also be included in the next update of our Provider Manual. ...
End of the COVID-19 Public Health Emergency FAQ
The COVID-19 National Emergency and PHE ended on May 11, 2023. Our FAQ provides a brief overview of changes for Medicare and Medicaid providers.
The FAQ includes:
Answers to general questions
An...
Prior authorization changes for July 2023
Effective July 3, 2023, PacificSource will require prior authorization codes 74740 (hysterosalpingography, radiological supervision and interpretation),...
Imaging and genetic testing review timelines change
As of March 24, 2023, Carelon Medical Benefits Management (formerly AIM Specialty Health) will review prospective and retroactive authorizations up to 60 calendar days from the date of...
What you need to know about Medicaid renewal
After a three-year pause, the process of checking member eligibility for renewing Medicaid health insurance coverage has begun again. It’s estimated that anywhere between 5 and 15 million people are...
OHLC shares guidelines for behavioral health via telehealth
The Oregon Health Leadership Council (OHLC) has created a guideline document for Telehealth Service Recommendations for Behavioral Health.
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Clinical policy changes
PacificSource has updated the following clinical policies:
Instrumented Spinal Surgery
Ocular Remodeling
Sleep Disorder Treatment
See our Clinical policies and practice guidelines for the...
AIM Specialty Health changing name to Carelon Medical Benefits Management
Effective March 1, 2023, AIM Specialty Health® is changing its name to Carelon Medical Benefits Management. PacificSource partners with AIM to administer prior authorizations for nonemergency...