- US Legal Forms
- Form Library
- More Forms
- More Multi-State Forms
- OR PacificSource Care Coordination Request Form 2016
Get OR PacificSource Care Coordination Request Form 2016-2024
Ment under PacificSource coverage. We understand your concern and will contact you (or your designee) to discuss your ongoing care needs. Please complete all applicable sections below, and return the form as soon as possible to: PacificSource Health Plans ATTN: Health Services Dept. PO Box 7068 Springfield, OR 97475-0068 Fax (541) 225-3625 If you have questions, please call Health Services at (541) 684-5584, or toll-free at (888) 691-8209 Employer/Group Name Date PacificSource coverage will be.
How It Works
-
Open form follow the instructions
-
Easily sign the form with your finger
-
Send filled & signed form or save
Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.
Applicable FAQ
-
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.
-
Email: CS@PacificSource.com. Fax: Mail: PacificSource Health Plans, PO Box 7068, Springfield, OR 97475-0068.
-
Birth control and contraceptives Your first prescription can be up to a 3-month supply. After that, you can receive a year's supply of the same prescription.
-
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.
-
The PacificSource brand includes PacificSource Health Plans, PacificSource Community Solutions, PacificSource Administrators Inc., and IPN. Individual health insurance, Medicare Advantage, Medicaid, group health, dental, vision, and prescription coverage, are available to residents of the Northwest.
-
The PacificSource brand includes PacificSource Health Plans, PacificSource Community Solutions, PacificSource Administrators Inc., and IPN. Individual health insurance, Medicare Advantage, Medicaid, group health, dental, vision, and prescription coverage, are available to residents of the Northwest.
-
You may contact the Health Services team by phone at 888-691-8209 or by fax: 541-225-3625.
-
Please Send All Claims to: PacificSource Health Plans Attn: Claims Department PO Box 7068 Springfield OR 97475-0068.
-
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.
-
Email: CS@PacificSource.com. Fax: Mail: PacificSource Health Plans, PO Box 7068, Springfield, OR 97475-0068.
-
Birth control and contraceptives Your first prescription can be up to a 3-month supply. After that, you can receive a year's supply of the same prescription.
-
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.
-
The PacificSource brand includes PacificSource Health Plans, PacificSource Community Solutions, PacificSource Administrators Inc., and IPN. Individual health insurance, Medicare Advantage, Medicaid, group health, dental, vision, and prescription coverage, are available to residents of the Northwest.
-
The PacificSource brand includes PacificSource Health Plans, PacificSource Community Solutions, PacificSource Administrators Inc., and IPN. Individual health insurance, Medicare Advantage, Medicaid, group health, dental, vision, and prescription coverage, are available to residents of the Northwest.
-
You may contact the Health Services team by phone at 888-691-8209 or by fax: 541-225-3625.
-
Please Send All Claims to: PacificSource Health Plans Attn: Claims Department PO Box 7068 Springfield OR 97475-0068.
Acknowledgement Related content
-
Forms, Policies and Resources
Release of Information form (outgoing) - to request Student Health records to be sent to...
Learn more -
2023-2024 PacificSource Health Plans International...
Apr 27, 2023 — You may send comments or feedback using the Contact Us form on our...
Learn more -
UO Student Health Benefits Plan Student Guide
Request Form from the Plan Sponsor, or PacificSource's Customer Service team....
Learn more -
Domestic Student Insurance Plan - Student Health...
You will need to submit the waiver application form, a copy of insurance cards ... OSU...
Learn more -
Coordinated Care Organizations (CCO) : Oregon...
Find contact information for Oregon's coordinated care organizations (the local health...
Learn more -
PacificSource Community Solutions (Columbia Gorge)
Oct 1, 2019 — (g) Respond to requests for Intensive Care Coordination screening services...
Learn more -
Graduate Student Insurance Plans
You will need to submit the waiver application form, copy of insurance cards...
Learn more -
Healthcare Integration Toolkit
Development and distribution of an Integration. Toolkit: • A universal Referral Form...
Learn more -
2022-2023 Portland State University
For a prescription claim form, go to pacificsource.com/psu. Prescriptions...
Learn more -
Q&A: Flexible Spending - Eugene School District 4J
Mental Health Care Coordination Service · Mental Health Resources · Suicide ... claim...
Learn more -
Employee Enrollment and Waiver Form
... PacificSource Health Plans may request or disclose health information about me or my...
Learn more -
Enrollment Application and Waiver of Coverage
If you need help filing a grievance, the PacificSource Customer Service Department is...
Learn more -
OHP Information
Call OHP at (800) 273-0557 if you are NOT currently assigned to Advantage, and request to...
Learn more -
LaneCare
Our staff can assist active OHP members in finding mental health counseling or treatment...
Learn more -
HIPAA Privacy Notice
Depending on the information requested, the caller may be asked to submit a signed...
Learn more -
OregonBenefit Book
Welcome to your PacificSource group health plan. Your employer offers this coverage to...
Learn more -
Health Education Classes
Find information online at PacificSource.com. Reimbursement Request Form. Please attach a...
Learn more -
Employee Benefits Handbook
Mar 1, 2021 — ... Claim Form that includes your ... The PacificSource Case Management...
Learn more -
Prior Authorization Information - Medicaid...
Completed DMEPOS Prior Authorization Request form; Supporting documentation, which ... For...
Learn more -
REQUEST FOR PROPOSAL
Sep 14, 2016 — The Purpose and Intent of this Request for Proposal (RFP) is to establish...
Learn more -
Change Health Care Commercial Par Payer Listing
Aug 9, 2017 — Providers should contact the EDI department at (810-230-2084) upon billing...
Learn more -
REQUEST FOR PROPOSAL
Sep 14, 2016 — The Purpose and Intent of this Request for Proposal (RFP) is to establish...
Learn more -
Coordinated Care Organizations (CCO) : Oregon...
Find contact information for Oregon's coordinated care organizations (the local health...
Learn more -
PacificSource Community Solutions (Columbia Gorge)
Oct 1, 2019 — (g) Respond to requests for Intensive Care Coordination screening services...
Learn more -
Untitled
... request letter, 2 hour fire rated plasterboard, Restaurants near south of the border...
Learn more -
Healthcare Integration Toolkit
Development and distribution of an Integration. Toolkit: • A universal Referral Form...
Learn more -
Health • Rates and Forms - the Idaho Department...
Jul 31, 2023 — For questions related to carrier filing requirements please contact Idaho...
Learn more -
Enrollment Application and Waiver of Coverage
If you need help filing a grievance, the PacificSource Customer Service Department is...
Learn more -
Employee Enrollment and Waiver Form
... PacificSource Health Plans may request or disclose health information about me or my...
Learn more -
Health Insurance | Deschutes County Oregon
PDF icon How to Submit a Claim to PacificSource (629 KB). PDF icon Consent Form to Receive...
Learn more -
Health Education Classes
Find information online at PacificSource.com. Reimbursement Request Form. Please attach a...
Learn more -
OregonBenefit Book
Welcome to your PacificSource group health plan. Your employer offers this coverage to...
Learn more -
Prior Authorization Information - Medicaid...
Completed Request for Prior Authorization form. Completed CMN form. Supporting...
Learn more -
Oregon State University - GSE
Oct 1, 2020 — Case management services may be initiated by PacificSource when there is...
Learn more -
PacificSource Community Solutions (Columbia Gorge)
Oct 1, 2019 — (g) Respond to requests for Intensive Care Coordination screening services...
Learn more -
PacificSource: MUS Employee Benefit Plan
Jul 1, 2016 — questions about your rights, this notice, or assistance, you can contact:...
Learn more -
Willamette University
Welcome to your PacificSource Student plan. Your plan includes a wide range of benefits...
Learn more -
Health Related Services
Apr 28, 2022 — ... request by phone or e-mail that the request form be e-mailed or...
Learn more -
of oregon department of consumer & business...
Dec 31, 2017 — request ofthe Idaho Insurance Department. The deposit was also ... care...
Learn more -
Pacific Source Health Plans MLR Examination Report
Mar 29, 2021 — ... Form, due to the errors identified during the examination in the 2015...
Learn more -
Evaluation of Oregon's 2017-2022 Medicaid Waiver
Oct 15, 2021 — The 2017-2022 waiver called on CCOs to implement recommendations from the...
Learn more -
LaneCare
Our staff can assist active OHP members in finding mental health counseling or treatment...
Learn more -
Community Health Workers
May 25, 2023 — Welcome! Community Health Workers: Approaches to Health Equity and...
Learn more -
Health • Rates and Forms - the Idaho Department...
Jul 31, 2023 — For questions related to carrier filing requirements please contact Idaho...
Learn more -
Retiree Benefits Enrollment Workbook
If you do not submit a new MUS MAP enrollment form by May 20, 2016, your current MUS MAP...
Learn more -
Retiree Annual Benefits Enrollment Workbook 2015...
Administered by Blue Cross Blue Shield: Customer Service 1-800-820-1674 or 447-8747...
Learn more -
Implementation of the Mental Health Parity and...
Jul 2, 2021 — and require an updated analysis (CMS 2016a). Conducting parity ... (These...
Learn more -
June 30, 2023 COLLECTIVE BARGAINING AGREEMENT ...
the appeal request form. Witnesses may include a representative from the Human Resources...
Learn more -
Special Recognition Abstracts from Center to...
Feb 13, 2020 — The topic areas for abstract submission include: Addressing the needs of...
Learn more -
Claims | Eugene, OR Website
To request a claim form, contact the Claims Team by phone or e-mail...
Learn more -
PacificSource Community Solutions (Central Oregon)
Oct 1, 2019 — (g) Respond to requests for Intensive Care Coordination screening services...
Learn more -
Procedure: Practice Level Workgroup
Oct 11, 2017 — Care Coordination: means the act of developing and organizing Child and...
Learn more -
Targeted Case Management
Oct 1, 2018 — SECTION 1 GENERAL INFORMATION AND ADMINISTRATION. SOUTH CAROLINA MEDICAID...
Learn more -
Health Related Services
Apr 28, 2022 — ... request by phone or e-mail that the request form be e-mailed or...
Learn more -
Pacific Source Health Plans MLR Examination Report
Mar 29, 2021 — ... Form, due to the errors identified during the examination in the 2015...
Learn more -
REQUEST FOR PROPOSAL
Sep 14, 2016 — The Purpose and Intent of this Request for Proposal (RFP) is to establish...
Learn more -
LaneCare
Our staff can assist active OHP members in finding mental health counseling or treatment...
Learn more -
Change Health Care Commercial Par Payer Listing
Aug 9, 2017 — Providers should contact the EDI department at (810-230-2084) upon billing...
Learn more -
Health • Rates and Forms - the Idaho Department...
Jul 31, 2023 — Forms and Checklists Idaho Filing Certification No Surprises Act Please...
Learn more -
REQUEST FOR PROPOSAL
Sep 14, 2016 — The Purpose and Intent of this Request for Proposal (RFP) is to establish...
Learn more -
Change Health Care Commercial Par Payer Listing
Aug 9, 2017 — Providers should contact the EDI department at (810-230-2084) upon billing...
Learn more -
Claims | Eugene, OR Website
To request a claim form, contact the Claims Team by phone or e-mail...
Learn more -
Targeted Case Management
Oct 1, 2018 — SECTION 1 GENERAL INFORMATION AND ADMINISTRATION. SOUTH CAROLINA MEDICAID...
Learn more -
Implementation of the Mental Health Parity and...
Jul 2, 2021 — and require an updated analysis (CMS 2016a). Conducting parity ... (These...
Learn more -
Procedure: Practice Level Workgroup
Oct 11, 2017 — Care Coordination: means the act of developing and organizing Child and...
Learn more -
PacificSource: MUS Employee Benefit Plan
Jul 1, 2016 — questions about your rights, this notice, or assistance, you can contact:...
Learn more -
Oregon State University - GSE
Oct 1, 2020 — Your healthcare provider can request preauthorization from the...
Learn more -
Community Health Workers
May 25, 2023 — Summer Prantl Nudelman has worked in the health care space for 15 years...
Learn more -
Willamette University
Welcome to your PacificSource Student plan. Your plan includes a wide range of benefits...
Learn more -
MAKING CONNECTIONS TO SOCIAL SUPPORT FOR A ...
Aug 11, 2022 — Ensuing discussions between PacificSource Health Plans, a nonprofit...
Learn more -
of oregon department of consumer & business...
Dec 31, 2017 — It qualified as a Coordinated Care Organization ... PacificSource...
Learn more -
Retiree Benefits
Jul 1, 2017 — Claim submission form at: www.choices.mus.edu/forms. (voluntary)...
Learn more -
Retiree Benefits Enrollment Workbook
If you do not submit a new MUS MAP enrollment form by May 20, 2016, your current MUS MAP...
Learn more -
Untitled
... Pacificsource administrators cobra, Casa sabicas! Types of lizards in south carolina...
Learn more -
June 30, 2023 COLLECTIVE BARGAINING AGREEMENT ...
the appeal request form. Witnesses may include a representative from the Human Resources...
Learn more -
Forms, Policies and Resources
Release of Information form (outgoing) - to request Student Health records to be sent to...
Learn more -
2023-2024 PacificSource Health Plans International...
Apr 27, 2023 — You may send comments or feedback using the Contact Us form on our...
Learn more -
UO Student Health Benefits Plan Student Guide
Request Form from the Plan Sponsor, or PacificSource's Customer Service team....
Learn more -
Oregon State University - GSE
... Contact Us form on our website, PacificSource.com. You may ... Pre-service Claim means...
Learn more -
Health Insurance | INTO OSU - Oregon State...
... form and a summary of your insurance ... If you need any assistance, please contact...
Learn more -
2022-2023 Portland State University
These completed forms must be submitted to PacificSource before PacificSource can...
Learn more -
Q&A: Flexible Spending - Eugene School District 4J
Mental Health Care Coordination Service · Mental Health Resources · Suicide ... claim...
Learn more -
HIPAA Privacy Notice
Depending on the information requested, the caller may be asked to submit a signed...
Learn more -
Health Clinic
Please fill out the forms here prior to your visit. ... We provide evaluation and...
Learn more
Related links form
Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.
Keywords relevant to OR PacificSource Care Coordination Request Form
- undersigned
- dob
- Attn
- hospitalization
- facilitating
- dependents
- applicable
- Acknowledgement
- psychotherapy
- enrollment
- DEPT
- dependency
- healthcare
- Hospice
- disclosed
USLegal fulfills industry-leading security and compliance standards.
-
VeriSign secured
#1 Internet-trusted security seal. Ensures that a website is free of malware attacks.
-
Accredited Business
Guarantees that a business meets BBB accreditation standards in the US and Canada.
-
TopTen Reviews
Highest customer reviews on one of the most highly-trusted product review platforms.