October 2023 Drug List Change Notification (Commercial)
Updates on Existing Criteria
October 2023. The following changes to criteria are effective October 22, 2023:
Prior Authorization Criteria – Clinical Updates...
Providers
Pharmacy Coverage Updates Effective September 15, 2023
We would like to inform you of changes to our PacificSource Community Solutions formulary and coverage policies....
September 2023 Drug List Change Notification (Commercial)
Updates on Existing Criteria
September 2023. The following changes to criteria are effective September 22, 2023:
Prior Authorization Criteria –...
Medicaid Grievance and Appeals policies updated
These updated documents contain policy guidance for the Medicaid Grievance and Appeals System. The changes will also be included in the next update of our Provider Manual. ...
August 2023 Drug List Change Notification (Commercial)
Updates on Existing Criteria
August 2023. The following changes to criteria are effective August 22, 2023:
Prior Authorization Criteria – Clinical...
End of the COVID-19 Public Health Emergency FAQ
The COVID-19 National Emergency and PHE ended on May 11, 2023. Our FAQ provides a brief overview of changes for Medicare and Medicaid providers.
The FAQ includes:
Answers to general questions
An...
July 2023 Drug List Change Notification (Commercial)
Updates on Existing Criteria
July 2023. The following changes to criteria are effective July 22, 2023:
Prior Authorization Criteria – Clinical...
CMS/NCCI designation for C-Code reimbursement
Beginning May 15, 2023, PacificSource Health Plans will use the CMS/National Correct Coding Initiative (NCCI) designation for the consideration of C-code reimbursements....
Prior authorization changes for July 2023
Effective July 3, 2023, PacificSource will require prior authorization codes 74740 (hysterosalpingography, radiological supervision and interpretation),...
Imaging and genetic testing review timelines change
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...