Articles

Effective August 16, 2021, Pacificsource will require prior authorization for the following codes: 61791 (Creation, Lesion, Stereotactic, Percutaneous, Neurolytic Agent; Trigeminal Medullary Tract) 77399 (Unlisted Proc, Radiation/Physics/Dosimetry & Treatment Devices & Special Services...

Updates on Existing Criteria July 2021. The following changes to criteria are effective July 22, 2021: Prior Authorization Criteria – Clinical Updates Arcalyst – add new indication of Recurrent Pericarditis Juxtapid – combine policy with new drug Evkeeza...

Special enrollment periods (SEP) in Idaho, Montana, Oregon, and Washington began in February or March. SEPs may include consumers on and off the exchange. Because each state has its own rules and dates, we’re providing a recap of dates and information about changing plans. Note about...

The American Rescue Plan (ARP) Act of 2021 includes COBRA subsidies and increases dependent care account maximums to help Americans. COBRA premium assistance Individuals may have 100% of COBRA premiums paid for a period of up to six months beginning on April 1, 2021.  Individuals will have a...

Updates on Existing Criteria: June 2021. The following changes to criteria are effective June 22, 2021: Prior Authorization Criteria – Clinical Updates Botox – Update appropriate treatment for bladder conditions Muscular Dystrophy RNA Therapy – Add Amondys 45...

Effective March 15, 2021, prior authorization for deep sedation will no longer be required for: 
•    Upper endoscopy,
•    Colonoscopy, and 
•    Combined colonoscopy/upper endoscopy This change pertains to CPT codes 00731 - 00732 and applies to members on our...

Effective January 21, 2021, when processing claims, PacificSource will follow ICD-10-CM guidelines on inappropriate diagnosis combinations. The current guideline states, “'An Excludes1 note indicates that the code excluded should never be used at the same time as the code above...

PacificSource Health Plans and PacificSource Community Solutions are notifying providers of COVID-19 vaccine reimbursements for dates of service on or after March 15, 2021....

Applications received April 1–30 will have an effective date of May 1, 2021.  This applies to:  New and existing enrollees On and off the Exchange No proof of prior coverage will be needed. Note about changing plans ...