Latest Notices and Updates
90-day Retro Preauthorization
Posted 10/10/14. We understand there are sometimes circumstances that can prevent timely preauthorization requests. Please remember, however, that preauthorizations may only be considered for retro-review if we hear from the ordering physician within 90 days. Starting in December 2014, we will send a letter to both the provider and member when this situation occurs, indicating the claim(s) affected and outlining the 90-day requirement. Read the provider letter.
Preauthorization Required for Elective Deliveries Before 39 Weeks
Posted 10/10/14. Effective September 1, 2014, for commercial plans, PacificSource will require preauthorization for nonmedically indicated (elective) induction of labor before 39 weeks gestational age. Read full notice, mailed on August 1, 2014.
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.
Autumn Provider Bulletin Top Stories
Click here to read our Autumn 2014 issue. The issue was emailed to participating providers on October 15, 2014, and included the following topics:
- Community Health Excellence: Helping People Get Better Care
- New Claim Payment Option: Virtual Credit Card (VCC)
- First Choice Network
- ICD-10 Final Rule News
- Claims Processing Changes Due to ACA’s Nondiscrimination Provision (Commercial)
- Billing for Capped Durable Medical Equipment (DME) (Medicare)
- L1 Modifier and Separately Billable Lab Fees (Medicare)
- Member Engagement Project – OHP Timely Reenrollment (Medicaid)
- And more
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.