News and updates

New prior authorization requirements for providers regarding certain behavioral health services

Here’s what you need to know: Coverage of Humira (adalimumab) through PacificSource Community Solutions will change to other, biosimilar formulations. Will I still be able to prescribe Humira?...

PacificSource Community Solutions (Medicaid) allows a 20-day skilled nursing facility (SNF) stay for individuals who qualify for skilled care. Prior authorization is not required for admission to a...

Effective January 1, 2024, PacificSource will begin completing utilization management reviews for members who have received 26 or more therapy/counseling...

Updates on Existing Criteria November 2023. The following changes to criteria are effective November 22, 2023: ...

For Medicaid plans: Effective November 1, 2023, a prior authorization will be required for CPT Code 26055 (Tendon Sheath Incision).

Flu season is just around the corner, and while many PacificSource members already plan to get their flu vaccine, reminders help. Here are five reasons to inspire those procrastinators...

For commercial plans (individual and group), fractional laser treatment (codes 0479T and 0480T) will require prior authorization effective November 1, 2023.

Updates on Existing Criteria October 2023. The following changes to criteria are effective October 22, 2023: Prior Authorization Criteria – Clinical Updates...

We’re excited to announce an easier-to-use experience where you can access your account and find all our services in one place. What changed...