Claims denied if diagnosis combinations are mutually exclusive
Effective January 21, 2021, when processing claims, PacificSource will follow ICD-10-CM guidelines on inappropriate diagnosis combinations.
The current guideline states, “'An...
News and updates
Update to COVID vaccine reimbursements
PacificSource Health Plans and PacificSource Community Solutions are notifying providers of COVID-19 vaccine reimbursements for dates of...
Idaho update: the special enrollment period has been extended through April 30
Applications received April 1–30 will have an effective date of May 1, 2021.
This applies to:
New and existing enrolleesOn...
May 2021 Drug List Change Notification
Updates on Existing Criteria:
May 2021. The following changes to criteria are effective May 22, 2021:
Prior Authorization Criteria – Clinical Updates
Carbaglu...
New Client Service Representative in Idaho
PacificSource Health Plans is pleased to announce Lisa Brown has been promoted to the role of Client Service Representative. Lisa will partner with you to provide service and support...
New special enrollment periods for individuals and families announced
Special enrollment periods (SEP) in Montana, Oregon, and Washington began February 15.
The uninsured enrollment period for Idaho begins March 1.
SEPs may include consumers on and off...
April 2021 Drug List Change Notification
Updates on Existing Criteria
April 2021. The following changes to criteria are effective April 22, 2021:
Preauthorization Criteria – Clinical Updates...
Added requirements for nuclear medicine and SPECT/CT codes
Effective May 17, 2021, PacificSource Health Plans will require prior authorization for the following nuclear medicine and SPECT/CT codes:...
March 2021 Drug List Change Notification
Updates on Existing Criteria:
March 2021. The following changes to criteria are effective March 22, 2021:
Preauthorization Criteria – Clinical Updates
Arcalyst...
What you need to know about the CAHPS surveys
Your commercial and Medicare patients may be asked to participate in the annual Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. The survey is overseen by a company called SPH...