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...
Providers
February 2023 Drug List Change Notification (Commercial)
Updates on Existing Criteria
February 2023. The following changes to criteria are effective February 22, 2023:
Prior Authorization Criteria – Clinical...
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...
Updates to AIM Specialty Health Advanced Imaging Clinical Appropriateness Guidelines
Effective for dates of service on and after April 9, 2023, the following updates will apply to the AIM Specialty Health Advanced Imaging Clinical Appropriateness Guidelines.
As part of the AIM...
See what’s new with our website’s provider section
To better serve our provider partners, we are proud to announce several enhancements to PacificSource.com, with the aim of helping you connect with the information you need more easily and...
Urgent Notice for Uprise Health (formerly known as RBH) contracted providers
As you may already be aware, Uprise Health, formerly known as Reliant Behavioral Health (RBH), has decided to terminate their contract with PacificSource. Please disregard this notice if you...
Genetic Testing Guideline Changes – Effective March 11, 2023
Effective for dates of service on and after March 11, 2023, AIM Specialty Health® (AIM) will transition to an updated set of Clinical Appropriateness Guidelines.
PacificSource has...
Important message for behavioral health and alternative care providers contracted with Uprise Health
Uprise Health, formerly known as Reliant Behavioral Health (RBH), recently announced they are terminating their contract with PacificSource Health Plans. Uprise Health is an independent provider...
On Behalf of OHA- Provider billing and member reimbursement for retroactive OHP Supplemental Benefits
To reimburse OHP members who paid your office for OHP Supplemental benefits now retroactively covered, please be sure to bill the member's coordinated care organization (CCO), dental care...
January 2023 Drug List Change Notification (Commercial)
Updates on Existing Criteria
January 2023. The following changes to criteria are effective January 22, 2023:
Prior Authorization Criteria – Clinical Updates...