Questions about getting a COVID-19 vaccine? See the latest on our blog

Latest Notices and Updates


On behalf of CMS: Medicare FFS Claims: 2% Payment Adjustment (Sequestration) update. Temporary Claims Hold Pending Congressional Action to Extend 2% Sequester Reduction Suspension

In anticipation of possible Congressional action to extend the 2% sequester reduction suspension, we instructed the Medicare Administrative Contractors (MACs) to hold all claims with dates of service on or after April 1, 2021, for a short period without affecting providers’ cash flow. This will minimize th
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We recently modified our Medicare Advantage PPO plans for Members to no longer report their PCP designation to PacificSource. Inadvertently, during implementation, letters were generated and sent to some Members specific to these plans.

 

If one of your patients has received such a letter, please advise to disregard. We are also sending out letters to members impacted that may have received the letter in error.

 

Please contact our Customer Service depa
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PacificSource COVID-19 Benefit and Reimbursement FAQ - Updated January 2021


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PacificSource Health Plans is dedicated to meeting the needs of our members, including the ability to locate appropriate care. Toward this goal, we are pleased to introduce a new partnership regarding provider data validation to better our Provider Directory. This partnership with BetterDoctor was effective January 2021.


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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 will require prior authorization for all of the following Nuclear Medicine and SPECT CT codes. Medicare Advantage prior authorization requirements will begin 6/1/2021.
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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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