Prior authorization changes for July 2023
Effective July 3, 2023, PacificSource will require prior authorization codes 74740 (hysterosalpingography, radiological supervision and interpretation),...
News and updates
Imaging and genetic testing review timelines change
As of March 24, 2023, Carelon Medical Benefits Management (formerly AIM Specialty Health) will review prospective and retroactive authorizations up to 60 calendar days from the date of...
What you need to know about Medicaid renewal
After a three-year pause, the process of checking member eligibility for renewing Medicaid health insurance coverage has begun again. It’s estimated that anywhere between 5 and 15 million people are...
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 full...
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...
New direct phone for Washington providers
Washington State providers now have a new direct phone to reach PacificSource Provider Services: 888-224-3556, TTY: 711. We accept all relay calls.
Contact Provider Services for...
Medicaid and Medicare Advantage claims pay hold
All PacificSource Community Solutions (OHP/Medicaid) claims with 2023 dates of service will be held while we validate correct pricing and benefits. This hold also applies to Medicare Advantage...
Annual Compliance Training
All providers and their staff are required to complete the Compliance & FWA Training annually. Please review the PacificSource Code of Conduct and the PacificSource Compliance and Program...
Behavioral health criteria changes delayed
Beginning in early 2023, PacificSource will use different criteria for level-of-care decisions (inpatient, residential, partial hospitalization, and intensive outpatient) for mental health treatment...