August 2023 Drug List Change Notification (Commercial)
Updates on Existing Criteria
August 2023. The following changes to criteria are effective August 22, 2023:
Prior Authorization Criteria – Clinical...
News and updates
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...
July 2023 Drug List Change Notification (Commercial)
Updates on Existing Criteria
July 2023. The following changes to criteria are effective July 22, 2023:
Prior Authorization Criteria – Clinical...
CMS/NCCI designation for C-Code reimbursement
Beginning May 15, 2023, PacificSource Health Plans will use the CMS/National Correct Coding Initiative (NCCI) designation for the consideration of C-code reimbursements....
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...
June 2023 Drug List Change Notification (Commercial)
Updates on Existing Criteria
June 2023. The following changes to criteria are effective June 22, 2023:
Prior Authorization Criteria – Clinical Updates...
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...
May 2023 Drug List Change Notification (Commercial)
Updates on Existing Criteria
May 2023. The following changes to criteria are effective May 22, 2023:
Prior Authorization Criteria – Clinical Updates...
Opioids MME Limit
The Centers for Disease Control, Oregon Health Authority, and the Centers for Medicare and Medicaid Services recommend clinicians carefully assess benefits and risks of prescribing high doses of...