Latest Notices and Updates


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


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CMS is placing a claims payment hold on all Inpatient and Long Term Care claims with discharge dates 10/1/18-10/22/18
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Inpatient Stay Update – only one IP reference number per stay.


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New High Risk Medication Alternative Drug Resource Document
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Breast Cancer Screening:

Breast Cancer Screening is a HEDIS preventative measure and is also included in the overall STAR rating for Medicare. 


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Free 1-hour training module with CMEs – Changing the Conversation About Pain: Pain is Everyone's Job
Lisa Millet, OHA Public Health Injury and Violence Prevention

Contact: Lisa Millet, Injury and Violence Prevention Manager, lisa.m.millet@state.or.us


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CMS is placing all IP claims (PART A) on a hold for dates of service on/after July 1, 2018 while the pricing files are being updated.  This will ensure proper payment going out.  
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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
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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.


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Prior Authorization Grid Updates
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