Providers
August 2021 Drug List Change Notification
Updates on Existing Criteria
August 2021. The following changes to criteria are effective August 22, 2021:
Prior Authorization Criteria – Clinical Updates...
Prior Authorization Criteria – Clinical Updates...
July 2021 Drug List Change Notification
Updates on Existing Criteria
July 2021. The following changes to criteria are effective July 22, 2021:
Prior Authorization Criteria – Clinical Updates
Arcalyst...
June 2021 Drug List Change Notification
Updates on Existing Criteria:
June 2021. The following changes to criteria are effective June 22, 2021:
Prior Authorization Criteria – Clinical Updates
Botox –...
Prior authorization change for deep sedation for upper endoscopy and colonoscopy
Effective March 15, 2021, prior authorization for deep sedation will no longer be required for:
• Upper endoscopy,
• Colonoscopy,...
• Upper endoscopy,
• Colonoscopy,...
Claims denied if diagnosis combinations are mutually exclusive
Effective January 21, 2021, when processing claims, PacificSource will follow ICD-10-CM guidelines on inappropriate diagnosis combinations.
The current guideline states, “'An...
Update to COVID vaccine reimbursements
PacificSource Health Plans and PacificSource Community Solutions are notifying providers of COVID-19 vaccine reimbursements for dates of...
May 2021 Drug List Change Notification
Updates on Existing Criteria:
May 2021. The following changes to criteria are effective May 22, 2021:
Prior Authorization Criteria – Clinical Updates
Carbaglu...
April 2021 Drug List Change Notification
Updates on Existing Criteria
April 2021. The following changes to criteria are effective April 22, 2021:
Preauthorization Criteria – Clinical Updates...
Added requirements for nuclear medicine and SPECT/CT codes
Effective May 17, 2021, PacificSource Health Plans will require prior authorization for the following nuclear medicine and SPECT/CT codes:...
March 2021 Drug List Change Notification
Updates on Existing Criteria:
March 2021. The following changes to criteria are effective March 22, 2021:
Preauthorization Criteria – Clinical Updates
Arcalyst...