Latest Notices and Updates
Winter Provider Bulletin Top Stories
Click here to read our Winter 2015 issue. The issue was emailed to participating providers on January 7, 2015, and included the following topics:
- InTouch News
- ICD-10 Costs May Be Lower than Expected
- Administrative News - Modifier 59 and the New X Modifiers, Ambulatory Surgery Centers (ASC), Discounted 2015 Code Books Still Available
- Commercial News
- Medicare Specific News
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.
Chart Review Initiative Begins Mid-January
Posted 12/24/14. We're conducting Risk Adjustment and HEDIS (Health Effectiveness Data Information Set) chart reviews to ensure compliance with program guidelines as set by the Department of Health and Human Services (HHS) and the National Committee for Quality Assurance (NCQA). Please read the full announcement to know what you can expect.
Oregon Law Changes OTJ-related Claims Processing
Posted 12/24/14. A new law in Oregon (HB 4104) prohibits medical claims from being denied initially on the basis they are related to on-the-job (OTJ) injuries or conditions. The law affects how we process these types of claims for commercial Oregon-based individual members and employer clients. To comply, we’re making some changes effective January 1, 2015, for new plans and upon renewal in 2015 for existing plans. Here’s what you need to know. Read more.
One Touch (Lifescan) Test Strips Exclusive Option for Commercial and Medicare
Posted 12/19/14. Effective January 1, 2015, One Touch (Lifescan) test strips will be the exclusive option for commercial and Medicare formularies. A free meter letter was sent in September to all PacificSource members currently using nonpreferred products. Many of these members will require new prescriptions for the One Touch test strips to replace their old prescription. For members who require nonpreferred products due to compatibility with monitoring devices or pumps, a preauthorization can be requested. Questions? Call (800) 624-6052, ext. 3784, or email email@example.com.
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.
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.