June 2021 Drug List Change Notification
Updates on Existing Criteria:
June 2021. The following changes to criteria are effective June 22, 2021:
Prior Authorization Criteria – Clinical Updates
Botox –...
News and updates
Prior authorization change for deep sedation for upper endoscopy and colonoscopy
Effective March 15, 2021, prior authorization for deep sedation will no longer be required for:
• Upper endoscopy,
• Colonoscopy,...
• Upper endoscopy,
• Colonoscopy,...
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...
Update to COVID vaccine reimbursements
PacificSource Health Plans and PacificSource Community Solutions are notifying providers of COVID-19 vaccine reimbursements for dates of...
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...
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...
Provider Notice: Billing for COVID-19 vaccines
Please note that providers may bill PacificSource for the administration of the vaccine, but not for the vaccine itself, which is paid for by the federal government. If you...