What’s New for Providers  

Latest Notices and Updates

PacificSource coverage for compounded medications is changing

Posted 9/30/14. From time to time, we make changes to our prescription drug benefits. In developing our medication coverage policies, it is our goal to provide access to medications with the best clinical results at the lowest costs. To support this goal, we will be changing how we cover compounded medications beginning October 15, 2014.... Read more.

Use Caution With Modifiers PA, PB, and PC

Please be careful when choosing certain modifiers. We have recently seen claims coming in with the following modifiers:

  • PA: Surgical or otherwise invasive procedure on the wrong body part
  • PB: Surgical or otherwise invasive procedure on the wrong patient
  • PC: Wrong surgery or other invasive procedure on patient

These modifiers signal a denial of the claim because they indicate that a "Never Event" took place. To avoid claims being denied and having to submit corrected claims with supporting documentation, please be sure you are using the appropriate modifiers. Thank you.  

Summer Provider Bulletin Top Stories

Click here to read our Summer 2014 issue. The issue was emailed to participating providers on July 9, 2014, and included the following topics:

  • ICD-10 Delay: Our Plan and the Latest News
  • PacificSource Diabetes Support Programs Address Growing Health Issue
  • Administrative News
  • Claims Processing Changes Due to ACA’s Nondiscrimination Provision (Commercial)
  • Nonreimbursed Nursing Level Charges During an Acute Care Hospital Stay (Commercial)
  • Drug Formulary and Coverage Changes Effective July 1, 2014 (Commercial)
  • Guidelines for Global Surgery Billing (Medicare)
  • Concierge-Style Customer Service Program Begins for Members (Medicare)
  • Part D Payment for Drugs for Beneficiaries Enrolled in Hospice (Medicare)
  • Improper Use of ABN (Medicare)
  • Medicare Advantage Chart Review Initiative Continues (Medicare)
  • Referral Guideline Update (Medicaid)
  • Claims Processing Edit Updates (Government Claims Corner)
  • Urological Supplies and Medicare Billing Guidance (Government Claims Corner)

If you did not receive your copy, please contact your Provider Service Representative, or sign up to receive future issues by completing our Opt-in Form.

Read the complete issue, or access past issues in our Newsletter Archive.  

Orders Now Being Taken for 2015 Code Books

As a participating provider, you can preorder code books through PacificSource at a discounted rate—and delivery is free! To order, simply complete the 2015 Code Book Order Form and mail it to us with your check. Full payment is required prior to delivery. 

Healthcare Reform: When to Expect Changes

The Affordable Care Act will eventually bring about many changes, but it's important to remember that those changes will not occur all at once. They will be phased in over the next decade. You'll find more information, FAQs, and links to online resource in our Healthcare Reform Resource Center.

InTouch for Providers

Access your PacificSource account information 24/7.

Log into InTouch

Register now. | Learn more about InTouch.

Have You Tried InTouch?

With InTouch for Providers, you can verify eligibility and check claims status, EOPs, preauthorizations, and much more online! Note: InTouch access is now through OneHealthPort. If you are already registered with OneHealthPort, you do not need to re-register. Ready to get started? Please read our Registration Information page.

Your Provider Service Representative

Your PacificSource Provider Service Representative is available any time you have a question or concern. If you're not sure who your representative is, please visit our Provider Service Staff Directory.

Last updated 9/30/2014