News and updates
Stay extensions available for members in skilled nursing facilities (Medicaid)
PacificSource Community Solutions (Medicaid) allows a 20-day skilled nursing facility (SNF) stay for individuals who qualify for skilled care. Prior authorization is not required for admission to a...
Behavioral Health treatment plans required in 2024
Effective January 1, 2024, PacificSource will begin completing utilization management reviews for members who have received 26 or more therapy/counseling visits....
November 2023 Drug List Change Notification (Commercial)
Updates on Existing Criteria
November 2023. The following changes to criteria are effective November 22, 2023:
...
Trigger finger or thumb surgical procedure will require prior authorization effective November 1, 2023
For Medicaid plans: Effective November 1, 2023, a prior authorization will be required for CPT Code 26055 (Tendon Sheath Incision).
Fractional laser treatment will require prior authorization
For commercial plans (individual and group), fractional laser treatment (codes 0479T and 0480T) will require prior authorization effective November 1, 2023.
October 2023 Drug List Change Notification (Commercial)
Updates on Existing Criteria
October 2023. The following changes to criteria are effective October 22, 2023:
Prior Authorization Criteria – Clinical Updates...
Pharmacy Coverage Updates Effective September 15, 2023
We would like to inform you of changes to our PacificSource Community Solutions formulary and coverage policies.
...
September 2023 Drug List Change Notification (Commercial)
Updates on Existing Criteria
September 2023. The following changes to criteria are effective September 22, 2023:
Prior Authorization Criteria – Clinical Updates...
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 Updates...