Provider Bulletin


Fall 2016

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General News and Information

PacificSource Honored with American Heart Association Platinum Fit-friendly Worksite Award >

Dr. Kristen Dillon Named Oregon Family Doctor of the Year >

DME Fee Schedule Change Reminder >

Fall Workshops Coming Soon! >

Save Time and Work More Efficiently with InTouch! >

Discounted 2017 Code Books >

Commercial News

PCP Names Removed from Commercial ID Cards >  

Medicaid and Medicare News

New Oregon CCO Incentive Measure: Cigarette Smoking Prevalence >

Genetic Testing Reminder for Medicare and Medicaid Patients >


General News and Information

PacificSource Honored with American Heart Association Platinum Fit-friendly Worksite Award

Like you, PacificSource Health Plans understand the importance of healthy behavior in the prevention of serious illnesses, and that extends to our own employees. So we’re pleased to announce that, once again, we have been recognized by The American Heart Association (AHA) as a Platinum-Level Fit-Friendly Worksite. We’re one of just four companies in Oregon, and one of 317 employers out of 2,393 applicants nationwide, to earn this elite recognition.

The AHA defines Platinum-Level Fit-Friendly Worksite employers as those organizations that promote a culture of wellness and offer their employees options for physical activity and healthy eating. They must also demonstrate measurable outcomes related to workplace wellness and implement at least nine criteria outlined by the AHA in the areas of physical activity, nutrition, and culture.

“Having a healthy workplace and culture helps our employees make positive, lasting health changes,” said Charis Allenbaugh, Health Promotions and Wellness Manager at PacificSource. “From sit-stand stations to on-site fitness classes to healthy snacks at staff meetings, we’re committed to making the healthy choice the convenient choice.”

Dr. Kristen Dillon Named Oregon Family Doctor of the Year

Earlier this year, the Oregon Academy of Family Physicians (OAFP) named Dr. Kristen Dillon, MD the 2016 Oregon Family Doctor of the Year. Dr. Dillon is Director of PacificSource's Columbia Gorge Coordinated Care Organization (CCO) and Associate Medicaid Medical Director.

This award recognizes physicians who provide compassionate, comprehensive family medicine on a continuing basis, are involved in community affairs, and who provide a credible role model professionally and personally to their community, other health professionals, and residents and medical students.

Dr. Dillon was honored at the OAFP's Annual Family Medicine Weekend on Saturday, March 12. She was also elected to the Board of Directors of the OAFP at the same celebration, a term that will last three years. 

"We are very fortunate to have Dr. Dillon on our team," said Ken Provencher, PacificSource President and CEO. "She is a key player in our efforts to improve the healthcare system to ensure that everyone gets the coverage they need."

DME Fee Schedule Change Reminder

As announced earlier this year, the Durable Medical Equipment (DME) reimbursement in your contract will reference the 2016 Centers for Medicare & Medicaid Services DMEPOS Rural fee schedule as of June 1, 2016. This change, as allowed by your contract, will bring your payment in line with Centers for Medicare & Medicaid Services pricing. This update will affect all contracted provider reimbursements for DME unless the contract includes an extended term or other special language tying reimbursement to a specific fee schedule.

Fall Workshops Coming Soon!

Our free provider workshops are a great way for you to learn the latest on PacificSource plan updates, quality initiatives, department updates, and more. We’re gearing up for Fall provider workshops now and will be sending more details soon. Watch your inbox for your invitation and be sure to register right away. These popular events fill up fast.

Save Time and Work More Efficiently with InTouch!

PacificSource has a great Customer Service department that handles your calls, but did you know you have another convenient option? InTouch for Providers, our secure web portal for providers at, can help you get the information you need right at your desktop. You can submit claims, check benefits, request prior authorizations, access the provider directory, and more, all online. Sounds easy? It is! 

InTouch is available through OneHealthPort. You can learn more, and view our InTouch overview video, at our About InTouch web page. After creating a login and password, you will have access to a great tool for your office. It’s quicker than calling and has real-time information. Visit to get started.

Discounted 2017 Code Books

You can pre-order 2017 code books through us at a discounted rate, and delivery is free! Simply complete the order form and mail it to us with your payment. Payment in full is required at the time of order.

Orders will be accepted through December 31, 2016. Please go to our Provider Forms and Materials page for the order form. 

Commercial News

PCP Names Removed from Commercial ID Cards  

We’re listening! Many of you have given us the feedback that the member’s effective date would be more useful information on ID cards than the member’s designated primary care provider (PCP) name. As of April 1, we’ve begun implementing this change. Newly printed commercial ID cards will no longer include the PCP name. Instead, the plan effective date will be printed in that space. The only exceptions to this are groups on our Prime plans.

New ID cards will be mailed out upon the plan renewal, or if the member calls to change their PCP.

If you’d like a list of members that have chosen you as PCP, check InTouch or contact your Provider Service Representative. 

Medicaid and Medicare News

New Oregon CCO Incentive Measure: Cigarette Smoking Prevalence  

Oregon Health Authority (OHA) has selected Cigarette Smoking Prevalence as a new Coordinated Care Organization (CCO) incentive measure beginning in 2016. The measure is intended to address cessation benefits offered by CCOs and to reduce cigarette smoking prevalence. 

The bundled measure has three components, and each component of the bundled measure is worth a certain score. CCOs must meet a threshold score of 60 percent in order to meet the measure for 2016. The scoring for the three components for 2016 is as follows:

Incentive Measure Components


Total score required for 2016

  • Meeting cessation benefit requirement (pass/fail)  

If the CCO does not meet this component, they cannot meet the measure



  • Reporting EHR-based prevalence data


  • Reducing prevalence (meeting benchmark / improvement target through EHR-submitted data)


What can you do? 

Prescribe cessation medications as appropriate.

    • PacificSource’s benefits and formulary have been designed to meet OHA’s minimum cessation benefit requirements.
    • An online search for related medications and any restrictions, such as quantity limits, can be found here: [Ed. note 1/4/18: Link updated]

Record smoking status and tobacco use in your EHR using structured data and following Meaningful Use standards.

    • PacificSource representatives will be contacting clinics soon to partner on EHR data submission for 2016 reporting.

Promote healthy behaviors, and encourage your patients to stop smoking today.

    • Patients are more likely to quit if encouraged by their healthcare provider.
    • Refer your patients to a smoking cessation program, such as The Quit For Life® Program, which is available to most PacificSource members at no cost. Visit for more information. (The Quit For Life® Program is brought to you by the American Cancer Society® and Alere Wellbeing.)

Additional information on the new 2016 Cigarette Smoking Prevalence CCO incentive measure (including guidance documents and technical specifications) is available on the OHA website:

Genetic Testing Reminder for Medicare and Medicaid Patients

As a friendly reminder, most genetic testing requires a prior authorization. If you are sending your patients to a lab for blood draws, please let them know they should ask the lab to request any required prior authorizations.

If your facility is a laboratory drawing blood for our members, please ensure you submit the appropriate prior authorization request when required or before referring a member to an out-of-network lab.

You may access our prior authorization code by visiting our website at [Ed. note 1/4/18: Link updated]

Contact Us


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PacificSource Community Health Plans is an HMO/PPO plan with a Medicare contract.