News and updates

Updates on Existing Criteria: September 2021. The following changes to criteria are effective September 22, 2021: Prior Authorization Criteria – Clinical Updates...

Effective August 30, 2021, PacificSource will require prior authorization for the following codes related to Optical Coherence Tomography for...

Updates on Existing Criteria August 2021. The following changes to criteria are effective August 22, 2021:
Prior Authorization Criteria – Clinical Updates...

Updates on Existing Criteria July 2021. The following changes to criteria are effective July 22, 2021: Prior Authorization Criteria – Clinical Updates Arcalyst...

Updates on Existing Criteria: June 2021. The following changes to criteria are effective June 22, 2021: Prior Authorization Criteria – Clinical Updates Botox –...

Effective March 15, 2021, prior authorization for deep sedation will no longer be required for: 
•    Upper endoscopy,
•    Colonoscopy,...

Effective January 21, 2021, when processing claims, PacificSource will follow ICD-10-CM guidelines on inappropriate diagnosis combinations. The current guideline states, “'An...

PacificSource Health Plans and PacificSource Community Solutions are notifying providers of COVID-19 vaccine reimbursements for dates of...

Updates on Existing Criteria: May 2021. The following changes to criteria are effective May 22, 2021: Prior Authorization Criteria – Clinical Updates Carbaglu...

Updates on Existing Criteria April 2021. The following changes to criteria are effective April 22, 2021: Preauthorization Criteria – Clinical Updates...