Beginning May 15, 2023, PacificSource Health Plans will use the CMS/National Correct Coding Initiative (NCCI) designation for the consideration of C-code reimbursements....

Effective July 3, 2023, PacificSource will require prior authorization codes 74740 (hysterosalpingography, radiological supervision and interpretation),...

As of March 24, 2023, Carelon Medical Benefits Management (formerly AIM Specialty Health) will review prospective and retroactive authorizations up to 60 calendar days from the date of...

Updates on Existing Criteria June 2023. The following changes to criteria are effective June 22, 2023:  Prior Authorization Criteria – Clinical Updates...

After a three-year pause, the process of checking member eligibility for renewing Medicaid health insurance coverage has begun again. It’s estimated that anywhere between 5 and 15 million people are...

Updates on Existing Criteria May 2023. The following changes to criteria are effective May 22, 2023:  Prior Authorization Criteria – Clinical Updates...

The Centers for Disease Control, Oregon Health Authority, and the Centers for Medicare and Medicaid Services recommend clinicians carefully assess benefits and risks of prescribing high doses of...

The Oregon Health Leadership Council (OHLC) has created a guideline document for Telehealth Service Recommendations for Behavioral Health. ...

PacificSource has updated the following clinical policies: Instrumented Spinal Surgery Ocular Remodeling Sleep Disorder Treatment See our Clinical policies and practice guidelines for the...

Updates on Existing Criteria April 2023. The following changes to criteria are effective April 22, 2023:  Prior Authorization Criteria – Clinical Updates...