News and updates

Sharing on behalf of OHA:  Oregon will not renew the longstanding waiver around EPSDT for children. The decision comes as a result of clear feedback from the community, advocates, children's...

Updates on Existing Criteria December 2022. The following changes to criteria are effective December 22, 2022: Prior Authorization Criteria – Clinical Updates...

According to CMS, RxDC Reporting is intended to enhance transparency and shed light on how prescription drugs contribute to the growth of healthcare spending and the cost of health coverage.* To...

Updates on Existing Criteria November 2022. The following changes to criteria are effective November 22, 2022: Prior Authorization Criteria – Clinical...

With electronic funds transfer (EFT), claim payments are deposited directly into your bank account, eliminating the wait time for paper checks. You may receive EFT payments in one of two...

We would like to inform you of changes to our PacificSource Community Solutions’ formulary and coverage policies. We have recently updated our prior authorization list and coverage policies. These...

Effective October 1, 2022, a prior authorization requirement will be added to Durable Medical Equipment (DME) that are not on OHA's fee schedule, are set to manual pricing, and/or are designated as...

These last few years of the COVID-19 pandemic have taught us not to take our health for granted. So it’s important to remember another virus—influenza (flu)—that comes along every year, and put the...

Updates on Existing Criteria October 2022. The following changes to criteria are effective October 22, 2022: Prior Authorization Criteria –...

Pre authorization requirement update Effective August 29, 2022 pre authorization is required for codes 96116, 96121, 96132, 96133, 96136, 96137, and 96146 Please visit the authorization grid to...