News and updates
May 2023 Drug List Change Notification (Commercial)
Updates on Existing Criteria
May 2023. The following changes to criteria are effective May 22, 2023:
Prior Authorization Criteria – Clinical Updates...
Opioids MME Limit
The Centers for Disease Control, Oregon Health Authority, and the Centers for Medicare and Medicaid Services recommend clinicians carefully assess benefits and risks of prescribing high doses of...
OHLC shares guidelines for behavioral health via telehealth
The Oregon Health Leadership Council (OHLC) has created a guideline document for Telehealth Service Recommendations for Behavioral Health.
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Clinical policy changes
PacificSource has updated the following clinical policies:
Instrumented Spinal Surgery
Ocular Remodeling
Sleep Disorder Treatment
See our Clinical policies and practice guidelines for the...
April 2023 Drug List Change Notification (Commercial)
Updates on Existing Criteria
April 2023. The following changes to criteria are effective April 22, 2023:
Prior Authorization Criteria – Clinical Updates...
Continuous glucose monitors (CGMs) – prior authorization effective April 1, 2023
Effective April 1, 2023, the following HCPC codes will require prior authorization (PA) when using the Durable Medical Equipment (DME) benefit.
A9276
A9277
A9278
E2102
E2103
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 Press...
March 2023 Drug List Change Notification (Commercial)
Updates on Existing Criteria
March 2023. The following changes to criteria are effective March 22, 2023:
Prior Authorization Criteria – Clinical...
AIM Specialty Health changing name to Carelon Medical Benefits Management
Effective March 1, 2023, AIM Specialty Health® is changing its name to Carelon Medical Benefits Management. PacificSource partners with AIM to administer prior authorizations for nonemergency...
Avoid high call volumes and save time with our online tools
With a new year comes new benefit questions, and with it, higher call volumes—which could lead to longer hold times.
While we’re always happy to assist you over the phone, we know your time is...