Clinical policy changes
PacificSource has updated the following clinical policies:
Instrumented Spinal Surgery
Ocular Remodeling
Sleep Disorder Treatment
See our Clinical policies and practice guidelines for the...
Providers
April 2023 Drug List Change Notification (Commercial)
Updates on Existing Criteria
April 2023. The following changes to criteria are effective April 22, 2023:
Prior Authorization Criteria – Clinical Updates...
Continuous glucose monitors (CGMs) – prior authorization effective April 1, 2023
Effective April 1, 2023, the following HCPC codes will require prior authorization (PA) when using the Durable Medical Equipment (DME) benefit.
A9276
A9277
A9278
E2102
E2103
What you need to know about the CAHPS surveys
Your commercial and Medicare clients may be asked to participate in the annual Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey. The survey is overseen by a company called Press...
March 2023 Drug List Change Notification (Commercial)
Updates on Existing Criteria
March 2023. The following changes to criteria are effective March 22, 2023:
Prior Authorization Criteria – Clinical...
AIM Specialty Health changing name to Carelon Medical Benefits Management
Effective March 1, 2023, AIM Specialty Health® is changing its name to Carelon Medical Benefits Management. PacificSource partners with AIM to administer prior authorizations for nonemergency...
Avoid high call volumes and save time with our online tools
With a new year comes new benefit questions, and with it, higher call volumes—which could lead to longer hold times.
While we’re always happy to assist you over the phone, we know your time is...
New direct phone for Washington providers
Washington State providers now have a new direct phone to reach PacificSource Provider Services: 888-224-3556, TTY: 711. We accept all relay calls.
Contact Provider Services...
Medicaid and Medicare Advantage claims pay hold
All PacificSource Community Solutions (OHP/Medicaid) claims with 2023 dates of service will be held while we validate correct pricing and benefits. This hold also applies to Medicare Advantage...
Annual Compliance Training
All providers and their staff are required to complete the Compliance & FWA Training annually. Please review the PacificSource Code of Conduct and the PacificSource Compliance and Program...