We help members deal with unexpected health and life challenges
Did you know PacificSource has a team of Member Support Specialists that help members with needs beyond healthcare? They work to remove roadblocks and help members through the...
News and updates
Advantage Dental acquisition will help build PacificSource dental networks
Effective March 31, PacificSource purchased Advantage Dental’s Medicare and Commercial dental contracts. What does this mean for...
Medicaid Grievance and Appeals policies updated
These updated documents contain policy guidance for the Medicaid Grievance and Appeals System. The changes will also be included in the next update of our Provider Manual. ...
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...
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...