These updated documents contain policy guidance for the Medicaid Grievance and Appeals System. Grievances Appeals and Hearings Member Information and Education RequirementsNotice of Adverse...

Updates on Existing CriteriaJuly 2024. The following changes to criteria are effective July 22, 2024:Prior Authorization Criteria –...

Clearinghouse services provided by Change Healthcare have been mostly restored, including eligibility status, remittance advice, and claims transmission, following a February cybersecurity event....

Here’s what providers should know if they want to provide health-related social needs (HRSN) services.Qualifications and process for becoming an HRSN service providerTo become an HRSN service...

Oregon Senate Bill 1529, now in effect, intends to expand access to care and improve health outcomes. The following is an overview of the law’s key requirements and what you can expect from...

Updates on Existing CriteriaJune 2024. The following changes to criteria are effective June 22, 2024:Prior Authorization Criteria –...

On Wednesday, February 21, 2024, Change Healthcare, one of our clearinghouse partners, was impacted by a cybersecurity event. This event compelled them to suspend business with all...

We have recently updated our prior authorization list and coverage policies. These changes are effective for dates of service on or after May 15, 2024....

Beginning June 22, 2024, coverage of Humira (adalimumab) through PacificSource Health Plans will change to other, biosimilar formulations. This change applies to commercial (Employer and Individual...

Updates on Existing CriteriaMay 2024. The following changes to criteria are effective May 22, 2024:Prior Authorization Criteria – Clinical...