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Get OR PacificSource Care Coordination Request Form 2021-2024

Coverage. We understand and are here to help you or your covered family members. By completing this form, we will be able to contact you (or your designee) to discuss your care and answer any remaining questions. First, please complete the applicable sections below and return this form as soon as possible to: PacificSource Health Plans, ATTN: Health Services Dept. PO Box 7068, Springfield, OR 97475-0068 Email: MSSTeamCommercial PacificSource.com Fax: 541-684-5486 Questions? 888-977-9299, TTY 7.

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