News and updates
Pharmacy Coverage Updates Effective September 15, 2023
We would like to inform you of changes to our PacificSource Community Solutions formulary and coverage policies.
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September 2023 Drug List Change Notification (Commercial)
Updates on Existing Criteria
September 2023. The following changes to criteria are effective September 22, 2023:
Prior Authorization Criteria –...
Easier access to care away from home
Effective June 1, 2023, PacificSource Health Plans has collaborated with Aetna Signature Administrators® to offer commercial members in-network access to Aetna’s broad...
We help members deal with unexpected health and life challenges
Did you know PacificSource has a team of Member Support Specialists that help members with needs beyond healthcare? They work to remove roadblocks and help members through the...
Advantage Dental acquisition will help build PacificSource dental networks
Effective March 31, PacificSource purchased Advantage Dental’s Medicare and Commercial dental contracts.
What does this mean for...
Medicaid Grievance and Appeals policies updated
These updated documents contain policy guidance for the Medicaid Grievance and Appeals System. The changes will also be included in the next update of our Provider Manual. ...
August 2023 Drug List Change Notification (Commercial)
Updates on Existing Criteria
August 2023. The following changes to criteria are effective August 22, 2023:
Prior Authorization Criteria – Clinical...
End of the COVID-19 Public Health Emergency FAQ
The COVID-19 National Emergency and PHE ended on May 11, 2023. Our FAQ provides a brief overview of changes for Medicare and Medicaid providers.
The FAQ includes:
Answers to general questions
An...
July 2023 Drug List Change Notification (Commercial)
Updates on Existing Criteria
July 2023. The following changes to criteria are effective July 22, 2023:
Prior Authorization Criteria – Clinical...
CMS/NCCI designation for C-Code reimbursement
Beginning May 15, 2023, PacificSource Health Plans will use the CMS/National Correct Coding Initiative (NCCI) designation for the consideration of C-code reimbursements....