News and updates
New resource available for caregivers of Medicare patients with dementia
Often times, patients with Alzheimer's disease or other forms of dementia are supported by a family caregiver—a valuable part of the patient’s care team. Now, these caregivers have a new...
Pharmacy coverage updates, effective September 15, 2024 (Medicaid)
We have recently updated our prior authorization list and coverage policies. These changes are effective for dates of service on or after September 15, 2024.Summary of changes...
September 2024 Drug List Change Notification (Commercial)
Updates on Existing CriteriaSeptember 2024. The following changes to criteria are effective September 22, 2024:Prior...
Understanding Section 125 rules for mid-year election changes
IRS Notice 2014-55 (PDF) expands the situations in which individuals may change their health coverage elections under a Section 125 (cafeteria) plan.Please note that plans are not required...
August 2024 Drug List Change Notification (Commercial)
Updates on Existing CriteriaAugust 2024. The following changes to criteria are effective August 22, 2024:Prior Authorization Criteria –...
July 2024 Drug List Change Notification (Commercial)
Updates on Existing CriteriaJuly 2024. The following changes to criteria are effective July 22, 2024:Prior Authorization Criteria –...
Most Change Healthcare services restored
Clearinghouse services provided by Change Healthcare have been mostly restored, including eligibility status, remittance advice, and claims transmission, following a February cybersecurity event....
Information for HRSN service providers
Here’s what providers should know if they want to provide health-related social needs (HRSN) services.Qualifications and process for becoming an HRSN service providerTo become an HRSN service...
Oregon’s Access to Primary Care law
Important details and what to expect Note: This law applies only to Oregon members who are covered by individual/family and fully insured...
Understanding Oregon Senate Bill 1529 access to primary care requirements
Oregon Senate Bill 1529, now in effect, intends to expand access to care and improve health outcomes. The following is an overview of the law’s key requirements and what you can expect from...