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Questions about getting a COVID-19 vaccine? See the latest on our blog

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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 – Update to coverage for Deficiency of the IL-1 Receptor Antagonist (DIRA) Targeted Immune...

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 Analytics. Participants are chosen at random, and we hope you’ll encourage patients to complete the...

What you need to know about the CAHPS surveys

Your commercial and Medicare clients 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 Analytics. Participants are chosen at random, and we hope you’ll encourage clients to complete the...

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 wish to bill for the vaccine as “reporting only,” you may do so by using a charge of $0.01....

Reporting requirement for providers using offshore contractors

PacificSource is required to meet standards set by multiple federal and state regulators as well as accrediting standards and contractual obligations to various groups. As a contracted entity of PacificSource, you are also responsible for complying with these requirements, and must ensure that your...

Maternity stay notifications no longer required

Effective January 1, 2021, PacificSource will be removing inpatient notification requirements for maternity hospital stays for members on all commercial and Medicaid plans. If you have any questions, please contact your Provider Service Representative, or email our Provider Service...

ACA reporting for 2020: deadlines and details

Employers, health insurers, and individuals will soon need to prepare for filing their 1094 and 1095 forms with the IRS. Here’s what you need to know to assist your clients with this requirement: 1095-C forms (from applicable employers) are due to employees by March 2, 2021....

February 2021 Drug List Change Notification

Updates on Existing Criteria: February 2021. The following changes to criteria are effective February 22, 2021: Preauthorization Criteria – Clinical Updates Ibrutinib – remove from General Oncology Agents Criteria with stand-alone criteria to include chronic...

UDS definitive drug testing code change

Effective January 1, 2021, PacificSource will allow testing codes G0480, G0481, G0482 and G0483 for members covered by our commercial plans. These codes will have a maximum benefit of 12 units per year. If...