Please be aware that all office services submitted with dates of service on or after May 1, 2017, must be billed under the service provider, in an ANSI 837P format (CMS 1500), and with the “office” place of service (POS).

Effective May 1, 2017, PacificSource will no longer accept provider-based billing of office services, regardless of the office location. We will deny as noncovered any office services billed on a UB claim form, and you will need to resubmit them in the correct format.

Claims in the following formats are not reimbursable:

• Claims billed with revenue codes 051x

• Evaluation and Management codes (CPT 99201-99215 and HCPC G0463) that are billed with revenue codes 0760 through 0769
• Claims with a “PO” modifier

Thank you for your cooperation. If you have any questions about this change, you’re welcome to contact your Provider Service Representative, or our Provider Services Department:

Email: providerservicerep@pacificsource.com

Phone – in Idaho and Montana: (541) 246-1459

Phone – in Oregon: (541) 246-1457