All Community Solutions (Medicaid) claims with 2021 dates of service are being held while we validate correct pricing and benefit configuration.  We anticipate these claims will be released by January 25, 2021. 

Please reach out to your Provider Service Representative should you have any questions

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Reminder, effective in January 2019, all PacificSource Medicare Advantage (MA) plans considered the specialties below as eligible for our members.

• Licensed Professional Counselors (LPC)

• Licensed Clinical Professional Counselor (LCPC)

• Licensed Marital and Family Therapists (LMFT)

• Licensed Mental Health Counselors (LMHC)

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Effective 4/1/2021, Pacificsource Health Plans and Pacificsource Medicare will require prior authorization for all of the following Nuclear Medicine and SPECT CT codes. 
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PacificSource does not require the vaccine CPT to be billed, as the vaccines are supplied by the government. 

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Dear Providers,

PacificSource is responsible for meeting standards for multiple federal and state regulations as well as accrediting standards and fulfilling obligations of contracts with various groups. As a contracted entity of PacificSource, you are also responsible for complying with these requirements and must ensure your contracted entities comply with applicable laws and regulations. . If you currently utilize or plan to work with an offshore subcontractor that uses member pr
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All Medicare Advantage claims with 2021 dates of service are being held while we validate correct pricing and benefit configuration.  We anticipate these claims will be released by January 25, 2021. 

 

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The Coronavirus Aid, Relief, and Economic Security (CARES) Act suspended the payment adjustment percentage of 2% applied to all Medicare Fee-For-Service (FFS) claims from May 1 through December 31.  The Consolidated Appropriations Act, 2021, signed into law on December 27, extends the suspension period to March 31, 2021.  

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Effective January 1, 2021 PacificSource will be implementing additional industry standard rejections that will occur at our front door once they pass through the Clearinghouse. This is an effort to help improve and ensure timely and accurate claims processing.
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Medical Drug Formulary Change Effective 1/1/2021
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We acknowledge the requests from our Behavioral Health provider communities who wish to continue to serve our members via Telehealth only visits post emergency declaration. We are currently evaluating at this time, and are looking to recent and expected state and federal guidance as we determine how best to meet the needs of providers and our members. We will be communicating to our provider communities once we have made a determination.
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