Latest Notices and Updates

If you have questions about any of the information on this page, you're welcome to contact us.

  • Idaho/Montana (800) 624-6052 ext 1459 7:00 a.m. – 5:00 p.m. MT
  • Oregon/Washington (800) 624-6052 ext 1457 7:00 a.m. – 5:00 a.m. PT

For claims questions, member benefits, and eligibility information, please contact our Customer Service team at (888) 977-9299. For provider issues, please contact your Provider Service Representative or call (855) 896-5208.

Home Health Prior Authorization Requirement Changes Effective January 1, 2020 

Good News for providers and members!  Effective January 1, 2020, PacificSource will no longer require a prior authorization for home health.  This includes home health:

  • Nursing
  • Social worker
  • Physical therapy 
  • Occupational therapy
  • Speech therapy services

Change to MME Limit

The Centers for Disease Control, Oregon Health Authority, and the Centers for Medicare and Medicaid Services have lowered their recommended daily Morphine Milligrams Equivalents (MME). In light of these new recommendations, PacificSource will initiate a limit of an accumulative 300 MME on December 16th, 2019, with continued titration to 90 MME.

Drug List Change Notifications Now 60 Days in Advance

Starting with December 2019 pharmacy updates, we will notify you of the monthly changes 60 days in advance. The notification will contain changes for the Preferred and state-based lists, as well as our medical utilization management criteria (preauthorization, step therapy criteria). See the December 2019 Drug List Change Notification for changes effective December 22, 2019.

Newborn Hearing Screening

In alignment with CMS, effective immediately CPT code 92586 when reported with a facility POS will be included in the payment to the facility only. CPT code 92586 reported by a provider on a professional claim with a facility POS locations 21 and 22 will be denied. Services performed in the office as part of a routine well child exam will remain payable. If you have any questions, please contact your Provider Service Representative.

Change to Billing Requirements, Office Surgery Suites and Fees

Change effective October 1, 2019: When billed in an office place of service, PacificSource Health Plans will not reimburse any service appended with modifier SU or FF—the costs associated with operating an office, using the facility, and using the equipment for any procedure. See Billing Requirements, Office Surgery Suites and Fees.

Genetic Testing Program Launch 

We have entered a new era of precision medicine, where treatments can be targeted and disease risks identified for individuals based on their unique genetic makeup. Today, there are thousands of genetic tests available, and the number is growing. Navigating this rapidly advancing area of medicine can be a challenge for your practice and your patients.

PacificSource is pleased to announce a new genetic testing program beginning July 1, 2019. (Prior authorization for genetic testing recently changed as well.) PacificSource has partnered with AIM Specialty Health® (AIM) to help ensure quality care while reducing costs associated with testing that is not evidence-based. In collaboration with you, our valued providers, our genetic testing program will ensure our members have access to appropriate testing. 

Learn more in our Genetic Testing Program FAQ (PDF).

Read the Provider Bulletin

Spring issue (PDF) articles include:

  • Tobacco Cessation: Providers Play Key Role
  • Help Patients Get (or Stay) Fit
  • CHE Open for Applications
  • Provider Webinars Coming Soon
  • Administrative News and Reminders

Commercial Prior Authorization Changes Effective 4/1/2019

Updated April 4: Please visit our Provider Preauthorization Search page to verify whether your patient’s procedure requires a prior authorization. Please contact our office should you have any questions.

Electronic Prior Authorization/InPatient Notification 2019

Updated April 23: Effective June 1, 2019, PacificSource Health Plans strongly encourages prior authorization and inpatient notification requests to be submitted via our provider portal, InTouch. We will be making outreach to your offices to assist you in getting an account created, and assist with any training.

If you do not have access to InTouch, please visit OneHealthPort.com and register. Visit InTouch for Providers for more information.

If you need help submitting prior authorizations or inpatient notifications please reach out to our office at (888) 977-9299. 

In some cases, your billing office may be using it already. If so, you can contact them to find out who your administrator is on the account, and they can contact One Health Port to have additional users added. This can include front desk personnel or anyone who needs to submit prior authorizations. 

Please do not hesitate to contact your Provider Service Representative should you have any questions. We will be happy to assist you in any training you might need to utilize this portal. 

Duplicate 1099 Forms

We would like to apologize for the duplicate 1099 forms your providers will be receiving during the next few weeks.  Our Tax Statement vendor unintentionally sent out duplicate mailings for our 1099 MISC statements.

Thank you for your understanding.

Code Books

PacificSource no longer offers discounted code books.

2019 Formulary Changes

This notification is to inform you of changes to our medical drug formulary for all PacificSource Medicare, Medicaid, and Commercial Plans. Effective January 1, 2019, the following changes apply:

Prior authorization will be required for the following medical codes 

Medical Drug Alternative

Prescription Drug Alternative

J1453
Emend (fosaprepitant) injection

Granisetron injection (J1626)

Ondansetron HCl Tablet 4 MG Oral

Ondansetron HCl Tablet 8 MG Oral

Ondansetron HCl Tablet 24 MG Oral (quantity limit may apply)

J2469 
Aloxi (palonosetron hydrochloride) injection

C9463
Aprepitant injection (Cinvanti)

C9464
Rolapitant (Varubi)

J9315
Romidepsin (Istodax)

J7504
Antihymocyte Globulin Equine (Atgam)

J1575
Immune globulin/hyaluronidase, (Hyqvia)

J9328
Temozolomide injection


Your action may be required:

  • Patients currently prescribed medications listed on the 2019 Formulary Changes may require new prescriptions for alternative medications. Note that some medications may not have alternatives. Please discuss the necessity of continuing prescribed medications with these patients.
  • If you feel it is medically necessary for a patient to continue a particular medication, please request a prior authorization. To request a prior authorization, submit pertinent documentation via the InTouch portal on our website or speak to a Pharmacy Services representative at one of these phone numbers: 
    • Pharmacy Services Commercial (844) 877-4803
    • Pharmacy Government Services (888) 437-7728

Remember: Oregon Prescription Drug Monitoring Program (PDMP) Now in Effect

As you may already know, Oregon House Bill 4143 requires all Oregon providers to register in the Prescription Drug Monitoring Program. Read more in our Provider Bulletin .

Subscribe to our Provider Bulletin e-newsletter! You can subscribe or unsubscribe at any time.   We value your privacy

New Medical Record Signature and Date Requirements

We are adopting the CMS signature requirements across all lines of business, to ensure that services have been accurately and fully documented, reviewed, and authenticated. All medical records, chart notes, procedures, and orders submitted for review must be signed and dated by the rendering practitioner.

  • A medical record that does not contain a valid signature may result in claim denials or recovery of overpayments.
  • Signatures added to documentation following a claim denial will not be accepted.

Handwritten and digital signatures

Handwritten signatures must appear on each entry, be legible, at least include the practitioner’s first initial and last name, and include the practitioner’s credentials (PA, DO, MD, etc.).

If using digitized or electronic signatures, the responsibility/authorship of the signature should be clearly defined. These signatures require a minimum of a date stamp (preferably with a time notation), a printed statement such as, “Electronically signed by,” followed by the practitioner’s name and credentials.

Restrictions

PacificSource may request a signature log with any review of medical records to verify a provider’s signature or initials.

Unacceptable signatures include signature stamps, missing signature on dictated and/or transcribed documentation, "signed but not read" notations, and illegible lines or marks.

Exceptions

PacificSource will permit the use of an attestation form when a signature or date has been inadvertently omitted. Late entries, addendums, or corrections to a medical record should bear the current date of that entry and should be signed by the person making the change.

For more information, please refer to section 4.4.1 of the Provider Manual.


InTouch for Providers

Access your PacificSource account information 24/7.

Medicaid Dental Providers

Learn more about our contracted dental provider networks for Medicaid dental services.

Learn more >

Dental Providers: Join Advantage Dental Today

Advantage Dental is the exclusive network for PacificSource Health Plans, and we’re growing throughout the Northwest. As a participating provider, you’ll enjoy the benefit of increased patient access. The contracting process is easy, and there are no fees to participate! 

To get started, go to Secure.AdvantageDental.com/Credentialing.

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 10/21/2019