News and updates

Certain codes will require prior authorization for Oregon Medicaid members.

Beginning November 13, 2023, PacificSource will use different criteria for level-of-care decisions for mental health treatment (including inpatient, residential, partial...

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

We have recently updated our prior authorization list and coverage policies. This change is effective for dates of service on or after November...

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).