Documents

• InTouch for Providers Resource Guide
  
• Provider Manual (Revised April 2020)
  

  The Provider Manual is your desktop reference for information about PacificSource Medicare policies and procedures. Updates are announced in the Provider Bulletin e-newsletter and on the Provider Newletters page of this Web site.

  If you have any questions or suggestions regarding this manual, you are welcome to contact your PacificSource Provider Service Representative at (800) 624-6052 ext. 2580 or email providerservicerep@pacificsource.com.

• High Risk Medication Safer Alternatives
  
• Opioid Changes FAQ 2019
  
• Safety and Monitoring Program FAQ for High Risk Medications
  
• Telehealth Talking Points FAQ
  
• Medicare AWV Telehealth Component Guide
  
• Povider FAQ (COVID-19)
  

Forms

• Care Coordination and Case Management Referral Form
  
• Contested Refund Form
  
• Corrected Claim Form
  
• CVS Caremark Mail Order Prescription Fax Form for Prescribers
  
• Health Services Prior Authorization Request Form
  
• EFT/ERA Election Form
  
• Hospice Pharmacy Prior Authorization Verification Form
  
• Inpatient Utilization Review Form
  
• Medicare Non-Coverage for Home Health
  
• Medicare Non-Coverage for Skilled Nursing Facilities
  
• Medicare Non-Coverage Instructions
  
• Pharmacy Prior Authorization Form
  
• Provider Appeal Form
  
• Waiver of Liability for Non-Contracted Provider Claim Appeals
  
• COVID-19 Provider Relief FAQ