News and updates
Pharmacy Coverage Updates Effective October 15, 2022
We would like to inform you of changes to our PacificSource Community Solutions’ formulary and coverage policies.
We have recently updated our prior authorization list and coverage policies. These...
Durable Medical Equipment Prior Authorization Requirements Effective 10/1/22
Effective October 1, 2022, a prior authorization requirement will be added to Durable Medical Equipment (DME) that are not on OHA's fee schedule, are set to manual pricing, and/or are designated as...
October 2022 Drug List Change Notification
Updates on Existing Criteria
October 2022. The following changes to criteria are effective October 22, 2022:
Prior Authorization Criteria –...
Pre authorization requirement update
Pre authorization requirement update
Effective August 29, 2022 pre authorization is required for codes 96116, 96121, 96132, 96133, 96136, 96137, and 96146
Please visit the authorization grid to...
Prior Authorization requirement on CPT 97010 - Effective 8/19/22
Prior Authorization requirement on CPT 97010 - Effective 8/19/22
September 2022 Drug List Change Notification
Updates on Existing Criteria
September 2022. The following changes to criteria are effective September 22, 2022:
Prior...
Beginning July 1, 2022 health care providers reimbursed with state funds will be required to work with certified or qualified health care interpreters
OHA distributed a news release on June 15th indicating that new rules made by the state Legislature’s passage of HB 2359 during the 2021 session related to use of qualified or certified health...
Behavioral Health Fee Schedule Increases (Medicaid)
Dear Behavioral Health Providers,
We want first to thank you for your continued care of our members. We have received several questions from our Behavioral Health provider partners requesting more...
Prior authorization change: Three-Dimensional (3D) Printed Orthopedic Implants
Effective August 1, 2022, PacificSource will require prior authorization for Three-Dimensional (3D) Printed Orthopedic Implants.
This change pertains to CPT codes 0559T, 0560T, and 0562T.
Visit our...
August 2022 Drug List Change Notification
Updates on Existing Criteria
August 2022. The following changes to criteria are effective August 22, 2022:
Prior Authorization Criteria – Clinical Updates...