This notification is to inform you of changes to our medical drug formulary for all PacificSource Medicare, Medicaid, and Commercial Plans.
Effective on 01/01/2019 our formulary will change
Inpatient Stay Update – only one IP reference number per stay.
Breast Cancer Screening:
Breast Cancer Screening is a HEDIS preventative measure and is also included in the overall STAR rating for Medicare.
PacificSource allows “incident to” billing for caregivers who are not eligible to be credentialed by PacificSource or a delegated credentialing entity. This provides practices the opportunity to fully utilize their staff appropriately. PacificSource does NOT allow incident to billing for practitioners who are eligible for credentialing.
Effective June 1, 2018, in order for a service to be considered for payment under the “incident to” billing policy, the modifier SA must be appen
Prolotherapy - Please be reminded that claims billed for trigger point injections, CPT 20552-20553, billed without the appropriate J-Code will be denied.
Nail Debridement - Please note that claims submitted for nail debridement must follow the LCD from Noridian Medicare.