Effective January 1, 2024, PacificSource will begin completing utilization management reviews for members who have received 26 or more therapy/counseling visits. Behavioral health providers will be contacted and asked to submit clinical information, which will be reviewed for ongoing service.
Clinical information required will include:
The purpose of these reviews are:
PacificSource will be verifying resources are being used appropriately. Claims may be pended if treatment plan documents are not received within 30 days of being requested.
Note: this is applicable to non-Certificate of Approval (COA) agencies/providers only.