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Providers

January 09, 2025

Pharmacy coverage for 90-day medications now available via retail (Medicaid)

PacificSource Community Solutions (Medicaid) members now have access to 90-day supplies of certain medications via retail in addition to mail order. This change gives your patients more...

Medicaid/OHP Providers

December 12, 2024

February 2025 Drug List Change Notification (Commercial)

Updates on Existing CriteriaJanuary 2025. The following changes to criteria are effective January 22, 2025:Prior Authorization Criteria –...

Individual & Family, and Employer Providers

December 10, 2024

December 2024 Formulary Provider Notification Pharmacy Coverage Updates

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...

Medicaid/OHP Providers

December 03, 2024

Behavioral Health treatment reviews required in 2024

Clarification and update. See frequently asked questions below.Effective January 1, 2024, PacificSource began completing utilization management reviews for...

Individual & Family, and Employer Medicaid/OHP Providers

November 13, 2024

January 2025 Drug List Change Notification (Commercial)

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

Individual & Family, and Employer Providers

October 15, 2024

December 2024 Drug List Change Notification (Commercial)

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

Individual & Family, and Employer Providers

October 01, 2024

November 2024 Community Solutions 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...

Medicaid/OHP Providers

September 18, 2024

November 2024 Drug List Change Notification (Commercial)

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

Individual & Family, and Employer Providers

September 18, 2024

Revised coding policies for Emergency Department outpatient facility Evaluation and Management

As part of our continued efforts to reinforce accurate coding practices, we are revising the current Emergency Department (ED) outpatient facility Evaluation and Management (E/M) coding reimbursement...

Individual & Family, and Employer Medicaid/OHP Providers

August 20, 2024

October 2024 Drug List Change Notification (Commercial)

Updates on Existing CriteriaThe following changes to criteria are effective October 22, 2024:Prior Authorization Criteria – Clinical UpdatesArikayce...

Individual & Family, and Employer Providers

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