Documents

• AIM Portal Genetic Testing User Guide
  
• AIM Portal Radiology and Cardiology Guide
  
• COVID-19 Benefit and Reimbursement Policy FAQ
  
• COVID-19 Diagnostic (Viral) Testing and Antibody (Serology) Testing Policy
  
• COVID-19 Provider Relief FAQ
  
• InTouch for Providers Resource Guide
  
• Medicare AWV Telehealth Component Guide
  
• Minimizing Polypharmacy In Older Adults
  
• Opioid Changes FAQ 2019
  
• Peer-to-Peer FAQ
  
• Provider Manual (Revised July 2021)
  

  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.

• Safety and Monitoring Program FAQ for High Risk Medications
  
• Telemedicine and Telehealth FAQ
  
• TransactRx
  

Forms

• Care Coordination and Case Management Referral Form
  
• Contested Refund Form
  
• Corrected Claim Form
  
• CVS Caremark Mail Order Prescription Fax Form for Prescribers
  
• EFT/ERA Election Form
  
• Health Services Prior Authorization Request 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
  
• Provider Information Request
  
• Provider OffShore Operations Attestation
  
• Waiver of Liability for Non-Contracted Provider Claim Appeals