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.