News and updates

Updates on Existing Criteria November 2023. The following changes to criteria are effective November 22, 2023: ...

For Medicaid plans: Effective November 1, 2023, a prior authorization will be required for CPT Code 26055 (Tendon Sheath Incision).

For commercial plans (individual and group), fractional laser treatment (codes 0479T and 0480T) will require prior authorization effective November 1, 2023.

Updates on Existing Criteria October 2023. The following changes to criteria are effective October 22, 2023: Prior Authorization Criteria – Clinical Updates...

We would like to inform you of changes to our PacificSource Community Solutions formulary and coverage policies. ...

Updates on Existing Criteria September 2023. The following changes to criteria are effective September 22, 2023:  Prior Authorization Criteria – Clinical Updates...

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. ...

Updates on Existing Criteria August 2023. The following changes to criteria are effective August 22, 2023:  Prior Authorization Criteria – Clinical Updates...

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...

Updates on Existing Criteria July 2023. The following changes to criteria are effective July 22, 2023:  Prior Authorization Criteria – Clinical Updates ...