Providers
Medicaid and Commercial Prior Authorization Changes
Commercial and Medicaid: Starting January 1, 2026, these services with the listed billing codes will require prior authorization for both Commercial and Medicaid plans:...
December 2025 Drug List Change Notification (Commercial)
Updates on Existing CriteriaDecember 2025. The following changes to criteria are effective December 22, 2025:
Prior Authorization...
Prior Authorization...
Medicaid Peer delivered services policy update
PacificSource Community Solutions has updated the peer-delivered services policy effective January 1, 2026.Clarifying criteria for service eligibility for peer-delivered services, including medical...
Update on PacificSource’s Lane County CCO Participation
PacificSource has made the difficult decision to exit the Lane County Coordinated Care Organization (CCO). This follows months of good-faith collaboration with the Oregon Health Authority (OHA) to...
November 2025 Community Solutions (Medicaid) formulary and coverage policies notification
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...
Montana State Based Drug List Change Notification (Commercial)
Updates on Existing CriteriaOctober 2025. The following changes to criteria are effective October 1, 2025:
Removed from Formulary...
Removed from Formulary...
October 2025 Drug List Change Notification (Commercial)
Updates on Existing CriteriaOctober 2025. The following changes to criteria are effective October 22, 2025:
Prior Authorization...
Prior Authorization...
September 2025 Community Solutions (Medicaid) formulary and coverage policies notification
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...
2025 Fall Provider Workshops
Coming this OctoberOur annual Provider Workshops return this fall, with sessions designed to keep you informed, connected, and ready for the year ahead.We’ll cover...
Medicaid Grievance and Appeals policies
These updated documents contain policy guidance for the Medicaid Grievance and Appeals System. Grievances Appeals and HearingsMember Information and Education RequirementsNotice of Adverse...