pacificsource.com Open in urlscan Pro
34.217.239.10  Public Scan

Form analysis
2 forms found in the DOM

GET

<form id="swiftype-search-box" method="get" accept-charset="UTF-8">
  <div class="form-item form-item-stq form-no-label form-group">
    <label for="edit-stq" class="visually-hidden">Search</label>
    <input class="st-default-search-input form-search form-control header-search" data-drupal-selector="edit-keys" type="search" id="edit-stq" name="stq" value="" size="15" maxlength="128" autocomplete="off" autocorrect="off" autocapitalize="off">
  </div>
</form>

GET

<form id="swiftype-search-box" method="get" accept-charset="UTF-8">
  <div class="form-item form-item-stq form-no-label form-group">
    <label for="edit-stq" class="visually-hidden">Search</label>
    <input class="st-default-search-input form-search form-control header-search" data-drupal-selector="edit-keys" type="search" id="edit-stq" name="stq" value="" size="15" maxlength="128" autocomplete="off" autocorrect="off" autocapitalize="off">
  </div>
</form>

Text Content

Menu
Menu
Search
Search
 * Shop PlansOpen submenu
 * MembersOpen submenu
 * EmployersOpen submenu
 * ProducersOpen submenu
 * ProvidersOpen submenu
 * ResourcesOpen submenu

 * Log in
 * Find a doctor(link is external)
 * Find a drug
 * Careers
 * Contact Us

Close submenuShop Plans
 * Individuals & FamiliesOpen submenu
 * EmployersOpen submenu
 * Dental
 * Medicare(link is external)
 * Medicaid

Close submenuIndividuals & Families
 * Individuals & Families Overview
 * View Plans(link is external)

Close submenuEmployers
 * Employers Overview
 * View Plans
 * Administrative Services
 * Small Group
 * Large Group
 * Self-Funded

Close submenuMembers
 * MembersOpen submenu
 * Medicare(link is external)
 * Medicaid
 * FSA & HRA
 * COBRA(link is external)

Close submenuMembers
 * Members Overview
 * New Members
 * Print ID Card(link is external)
 * Plan Information
 * Getting CareOpen submenu
 * Healthy ResourcesOpen submenu
 * Behavioral Health Services
 * Prescription Drug InformationOpen submenu
 * Vision
 * Dental
 * About InTouch for Members
 * Make a Payment

Close submenuGetting Care
 * Getting Care Overview
 * Find a Doctor
 * Your Member ID
 * Telehealth
 * Urgent and Emergency Care
 * Explanation of Benefits
 * Prior Authorization
 * Member Support Specialists

Close submenuHealthy Resources
 * Healthy Resources Overview
 * Fitness Center Discount
 * Wellness – Virgin Pulse
 * Weight Management
 * Condition Support Program
 * Tobacco Cessation Program
 * Prenatal Program
 * Flu Prevention
 * Health Ed Reimbursement
 * Global Emergency Services
 * Rare Disease Program

Close submenuPrescription Drug Information
 * Prescription Drug Information Overview
 * Find a Drug
 * Find a Pharmacy
 * Drug Resources
 * Lists and Criteria
 * Drug Costs

Close submenuEmployers
 * Employers Overview
 * Employer InTouch(link is external)
 * FSA & HRA(link is external)
 * COBRA(link is external)
 * WellnessOpen submenu
 * Flu Clinic
 * Documents and Forms

Close submenuWellness
 * Wellness Resources
 * Wellness Toolkits
 * Wellness Consulting

Close submenuProducers
 * Producers Overview
 * Plan Details
 * InTouch for Producers(link is external)
 * Get Quotes and Materials
 * Get Appointed
 * Documents and Forms

Close submenuProviders
 * Providers Overview
 * Claims and BillingOpen submenu
 * Prior AuthorizationOpen submenu
 * Resources and GuidesOpen submenu
 * Education
 * Partner with Us
 * Contact Provider Services
 * Medicare(link is external)

Close submenuClaims and Billing
 * Provider Portal
 * Claims Guidelines: Medical
 * Claims Guidelines: Dental
 * Appeals
 * Electronic Transactions
 * Medicaid Behavioral Health Directed Payments

Close submenuPrior Authorization
 * Prior Authorization: Medical
 * Prior Authorization: Dental
 * Authorization Grid(link is external)

Close submenuResources and Guides
 * Documents and Forms
 * Prescription Drug Resources
 * Provider Resource Center
 * Provider Manual
 * Clinical Policies & Practice Guidelines
 * News and Updates

Close submenuResources
 * Resources Overview
 * Learning CenterOpen submenu
 * Documents and Forms
 * myPacificSource Mobile App

Close submenuLearning Center
 * Learning Center Overview
 * Health Library(link is external)
 * Glossary
 * News and Updates
 * Video Library
 * FAQ

Skip to main content




 *  * Find a:
      * Doctor
      * Drug

 * Search
   Search

 * Shop Plans
    * Individuals & Families
    * Employers
    * Dental
    * Medicare(link is external)
    * Medicaid
   
    * Individuals & Families Overview
    * View Plans(link is external)
   
   
    * Employers Overview
    * View Plans
    * Administrative Services
    * Small Group
    * Large Group
    * Self-Funded
   
   
   
   INDIVIDUALS & FAMILIES
   
   
   
   INDIVIDUALS & FAMILIES OVERVIEW
   
   
   
   VIEW PLANS
   
   View Individual & Family Plans
   
   EMPLOYERS
   
   
   
   EMPLOYERS OVERVIEW
   
   
   
   VIEW PLANS
   
   View Employer Plans
   
   ADMINISTRATIVE SERVICES
   
   
   
   SMALL GROUP
   
   
   
   LARGE GROUP
   
   
   
   SELF-FUNDED
   
   
   
   DENTAL
   
   Employers > Dental
   
   MEDICARE
   
   
   
   MEDICAID
   
   

 * Members
    * Members
    * Medicare(link is external)
    * Medicaid
    * FSA & HRA
    * COBRA(link is external)
   
    * Members Overview
    * New Members
    * Print ID Card(link is external)
    * Plan Information
    * Getting Care
    * Healthy Resources
    * Behavioral Health Services
    * Prescription Drug Information
    * Vision
    * Dental
    * About InTouch for Members
    * Make a Payment
   
    * Getting Care Overview
    * Find a Doctor
    * Your Member ID
    * Telehealth
    * Urgent and Emergency Care
    * Explanation of Benefits
    * Prior Authorization
    * Member Support Specialists
   
    * Healthy Resources Overview
    * Fitness Center Discount
    * Wellness – Virgin Pulse
    * Weight Management
    * Condition Support Program
    * Tobacco Cessation Program
    * Prenatal Program
    * Flu Prevention
    * Health Ed Reimbursement
    * Global Emergency Services
    * Rare Disease Program
   
    * Prescription Drug Information Overview
    * Find a Drug
    * Find a Pharmacy
    * Drug Resources
    * Lists and Criteria
    * Drug Costs
   
   MEMBERS
   
   Members > Members
   
   MEMBERS OVERVIEW
   
   
   
   NEW MEMBERS
   
   
   
   PRINT ID CARD
   
   Print ID Card
   
   PLAN INFORMATION
   
   Members > Plan Information
   
   GETTING CARE
   
   
   
   GETTING CARE OVERVIEW
   
   
   
   FIND A DOCTOR
   
   
   
   YOUR MEMBER ID
   
   
   
   TELEHEALTH
   
   
   
   URGENT AND EMERGENCY CARE
   
   
   
   EXPLANATION OF BENEFITS
   
   
   
   PRIOR AUTHORIZATION
   
   
   
   MEMBER SUPPORT SPECIALISTS
   
   
   
   HEALTHY RESOURCES
   
   
   
   HEALTHY RESOURCES OVERVIEW
   
   
   
   FITNESS CENTER DISCOUNT
   
   
   
   WELLNESS – VIRGIN PULSE
   
   Wellness – Virgin Pulse
   
   WEIGHT MANAGEMENT
   
   
   
   CONDITION SUPPORT PROGRAM
   
   
   
   TOBACCO CESSATION PROGRAM
   
   
   
   PRENATAL PROGRAM
   
   
   
   FLU PREVENTION
   
   
   
   HEALTH ED REIMBURSEMENT
   
   
   
   GLOBAL EMERGENCY SERVICES
   
   
   
   RARE DISEASE PROGRAM
   
   
   
   BEHAVIORAL HEALTH SERVICES
   
   
   
   PRESCRIPTION DRUG INFORMATION
   
   Members > Individuals > Pharmacy Information
   
   PRESCRIPTION DRUG INFORMATION OVERVIEW
   
   
   
   FIND A DRUG
   
   
   
   FIND A PHARMACY
   
   
   
   DRUG RESOURCES
   
   
   
   LISTS AND CRITERIA
   
   
   
   DRUG COSTS
   
   
   
   VISION
   
   Members > Vision
   
   DENTAL
   
   Members > Individuals > Dental
   
   ABOUT INTOUCH FOR MEMBERS
   
   
   
   MAKE A PAYMENT
   
   
   
   MEDICARE
   
   Members > Medicare
   
   MEDICAID
   
   Members > Medicaid
   
   FSA & HRA
   
   Flexible Spending Accounts and Health Reimbursement Arrangements
   
   COBRA
   
   COBRA

 * Employers
    * Employers Overview
    * Employer InTouch(link is external)
    * FSA & HRA(link is external)
    * COBRA(link is external)
    * Wellness
    * Flu Clinic
    * Documents and Forms
   
    * Wellness Resources
    * Wellness Toolkits
    * Wellness Consulting
   
   
   
   EMPLOYERS OVERVIEW
   
   Employers > Employers Overview
   
   EMPLOYER INTOUCH
   
   Members > Employers > Employer InTouch
   
   FSA & HRA
   
   
   
   COBRA
   
   
   
   WELLNESS
   
   
   
   WELLNESS RESOURCES
   
   
   
   WELLNESS TOOLKITS
   
   
   
   WELLNESS CONSULTING
   
   
   
   FLU CLINIC
   
   Members > Employers > Flu Clinic
   
   DOCUMENTS AND FORMS
   
   Members > Employers > Documents & Forms

 * Producers
    * Producers Overview
    * Plan Details
    * InTouch for Producers(link is external)
    * Get Quotes and Materials
    * Get Appointed
    * Documents and Forms
   
   
   
   PRODUCERS OVERVIEW
   
   
   
   PLAN DETAILS
   
   
   
   INTOUCH FOR PRODUCERS
   
   
   
   GET QUOTES AND MATERIALS
   
   
   
   GET APPOINTED
   
   
   
   DOCUMENTS AND FORMS
   
   

 * Providers
    * Providers Overview
    * Claims and Billing
    * Prior Authorization
    * Resources and Guides
    * Education
    * Partner with Us
    * Contact Provider Services
    * Medicare(link is external)
   
    * Provider Portal
    * Claims Guidelines: Medical
    * Claims Guidelines: Dental
    * Appeals
    * Electronic Transactions
    * Medicaid Behavioral Health Directed Payments
   
   
    * Prior Authorization: Medical
    * Prior Authorization: Dental
    * Authorization Grid(link is external)
   
   
    * Documents and Forms
    * Prescription Drug Resources
    * Provider Resource Center
    * Provider Manual
    * Clinical Policies & Practice Guidelines
    * News and Updates
   
   
   
   PROVIDERS OVERVIEW
   
   
   
   CLAIMS AND BILLING
   
   
   
   PROVIDER PORTAL
   
   
   
   CLAIMS GUIDELINES: MEDICAL
   
   
   
   CLAIMS GUIDELINES: DENTAL
   
   
   
   APPEALS
   
   
   
   ELECTRONIC TRANSACTIONS
   
   
   
   MEDICAID BEHAVIORAL HEALTH DIRECTED PAYMENTS
   
   
   
   PRIOR AUTHORIZATION
   
   
   
   PRIOR AUTHORIZATION: MEDICAL
   
   
   
   PRIOR AUTHORIZATION: DENTAL
   
   
   
   AUTHORIZATION GRID
   
   
   
   RESOURCES AND GUIDES
   
   
   
   DOCUMENTS AND FORMS
   
   
   
   PRESCRIPTION DRUG RESOURCES
   
   
   
   PROVIDER RESOURCE CENTER
   
   
   
   PROVIDER MANUAL
   
   View the Provider Manual
   
   CLINICAL POLICIES & PRACTICE GUIDELINES
   
   
   
   NEWS AND UPDATES
   
   
   
   EDUCATION
   
   
   
   PARTNER WITH US
   
   
   
   CONTACT PROVIDER SERVICES
   
   
   
   MEDICARE
   
   

 * Resources
    * Resources Overview
    * Learning Center
    * Documents and Forms
    * myPacificSource Mobile App
   
    * Learning Center Overview
    * Health Library(link is external)
    * Glossary
    * News and Updates
    * Video Library
    * FAQ
   
   
   
   RESOURCES OVERVIEW
   
   
   
   LEARNING CENTER
   
   
   
   LEARNING CENTER OVERVIEW
   
   
   
   HEALTH LIBRARY
   
   
   
   GLOSSARY
   
   
   
   NEWS AND UPDATES
   
   
   
   VIDEO LIBRARY
   
   Video Library
   
   FAQ
   
   
   
   DOCUMENTS AND FORMS
   
   Documents and Forms
   
   MYPACIFICSOURCE MOBILE APP
   
   

 * * Careers
   * Contact Us
   * Log in

 1. Providers Overview
 2. Medical Claims Guidelines


MEDICAL CLAIMS GUIDELINES

Get a PacificSource payor ID, find clearinghouse contacts, and read the
PacificSource guidelines for medical claims.


PAYOR IDS

Choose the correct Payor ID numbers based on the patient's type of
insurance. Learn more about our HIPAA electronic transaction capabilities.

COMMERCIAL:

93029

MEDICAID:

20416

MEDICARE:

20377

PACIFICSOURCE ADMINISTRATORS, INC:

93031


CHOOSING A CLEARINGHOUSE

We contract with the clearinghouses below to transmit professional,
institutional, and dental claims electronically.

You may use one of these clearinghouses, or any other. If you use a
clearinghouse not listed below, your clearinghouse should forward your claims to
one of our contracted clearinghouses.

To find out more, contact the clearinghouse directly, or get in touch with your
PacificSource Provider Service Representative.

Availity (formerly Health E Web) 
5555 Gate Pkwy, Suite 110
Jacksonville, FL 32256
Availity.com(link is external)
Transactions: professional and institutional claims,
835 remittance
Trading Partner ID: 810525733

Change Healthcare (formerly Emdeon, McKesson, MCPS, McKesson/RelayHealth) 
3055 Lebanon Pike 
Nashville, TN 37214
844-217-1199 
ChangeHealthcare.com(link is external) 
Transactions: professional, institutional, and dental claims;
835 remittance

Trading Partners ID:

 * Emdeon - 133052274
 * EmdeonDental - 061267267
 * McKesson - 943207296
 * MCPS - MCPS

inMediata (formerly SecureEDI)
4235 S Stream Blvd. 
Charlotte, NC 28217
877-466-9656
inMediata.com(link is external)
Transactions: dental claims
Trading Partner ID: 364187943

Office Ally
PO Box 872020
Vancouver, WA 98687
866-575-4120
OfficeAlly.com(link is external)
Transactions: professional and institutional claims,
835 remittance
Trading Partner ID: 330897513

Payer Connection
4000 Kruse Way Place Bldg 1 Suite 200, 
Lake Oswego, OR 97035
503-820-3803
PayerConnection.com(link is external)
Transactions: professional and institutional claims, 835 remittance
Trading Partner ID: P030489109, S030489109 (PSA)

Trizetto Provider Solutions (formerly GatewayEDI)
3300 Rider Trail South
Earth City, MO 63045
800-969-3666
TrizettoProvider.com(link is external)
Transactions: professional and institutional claims,
835 remittance
Trading Partner ID: GATEWAYEDI

Waystar (formerly Zirmed)
888 West Market Street
Louisville, KY 40202
Main: 866-537-1362
Sales: 844-899-5945
Waystar.com(link is external)
Transactions: Professional and institutional claims,
835 remittance
Trading Partner ID: 611340767


IMPORTANT GUIDELINES FOR YOUR CLAIM SUBMISSIONS

The fastest way to get your claims processed is to submit them electronically on
InTouch(link is external), our provider portal.

Sign in(link is external)

For paper claims, we use imaging technology to process your claims as quickly
and accurately as possible. You can help us by following these guidelines:

 * Submit applicable HCFA or UB form.
 * Make sure the print is dark, clear, and free of smudges.
 * Use 10- to 12-point black or blue type.
 * Make sure all information is aligned within the appropriate box.
 * Include only information needed for that claim.
 * Use only one code per service line.
 * Circle any specific pertinent information.
 * Include the diagnosis appropriate to the date of service in Box 21(1) (HCFA).
 * Include any diagnosis corresponding to Box 21(1) in Box 24(E) (HCFA).
 * Include your federal tax ID number in Box 25 (HCFA).
 * Please be sure to include the NDC (National Drug Code).


MAIL YOUR PAPER CLAIMS

MEDICAID

PacificSource Community Solutions
PO Box 7068
Springfield, OR 97475-0068

COMMERCIAL

PacificSource Commercial
PO Box 7068
Springfield, OR 97475-0068


BILLING MEDICAID MEMBERS

Providers generally should not bill our Medicaid members, but there are a few
exceptions. Learn more about these billing exceptions in our Provider Manual.

Download Provider Manual

 * About
 * Our Mission
 * History
 * Executive Team
 * Board of Directors
 * Company News
 * Office Locations
 * Careers

 * Community
 * A Culture of Helping
 * Not-for-Profit Status
 * Investing in Our Communities

 * Resources
 * Contact Us
 * Member ID Card(link is external)
 * InTouch Online Portal(link is external)
 * Health Library(link is external)

 * Products
 * Individual and Families
 * Employers
 * Administrative Services
 * Medicare(link is external)
 * Medicaid

 * 
 * 
 * 
 * 
 * 
 * 

 * 
 * 

Back to top

Non-discrimination Notice | Security | Interoperability & Transparency | Terms
of Service | Notice of Privacy Practice

Products provided by PacificSource Health Plans, PacificSource Community
Solutions, PacificSource Community Health Plans, or PacificSource
Administrators, Inc.
PacificSource Community Health Plans is an HMO, HMO-DSNP, and PPO plan with a
Medicare contract and a contract with Oregon Health Plan (Medicaid). Enrollment
in PacificSource Medicare depends on contract renewal.

© 2024 PacificSource. All rights reserved.


Close menu