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  • Pscs Provider Appeal Form - Pacificsource Community Solutions

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Provider Appeal Form IMPORTANT: ? Do NOT use this form for reconsideration of untimely, duplicate, or corrected claims. You may submit those requests via the claims department with explanation/supporting.

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800-431-4135, TTY: 711 Please don't email personal information.

When this happens, it becomes your responsibility to submit your claim to us for processing. All claims for benefits must be turned in to PacificSource within 90 days of the date of service. If it is not possible to submit a claim within 90 days, turn in the claim with an explanation as soon as possible.

Remit a check or money order made payable to PacificSource Administrators and mail it, along with a copy of this notice, to PacificSource Administrators Refunds, PO Box 70168, Springfield, OR 97475.

Call us to file a complaint Contact our Customer Service team at 800-431-4135, TTY: 711.

In Oregon, Medicaid is called the Oregon Health Plan, or “OHP,” and is run by the Oregon Health Authority. In specific regions in Oregon, PacificSource Community Solutions coordinates your care and manages your OHP benefits.

800-431-4135, TTY: 711.

Sign in or register, then follow the prompts to upload a copy of your receipt. (Instructions.) Or submit a paper claim to Caremark. For questions or concerns, please call us at 888-977-9299, TTY 711 (we accept all relay calls), or email CS@PacificSource.com.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232