How to File a Claim
A Member’s Step-by-Step Guide to Submit a Medical, Pharmacy, or Dental Claim
In most cases, your provider will submit your claim for you. Sometimes, a provider may bill you directly instead of submitting a claim to PacificSource. For example, non-participating providers (those that do not participate in our provider networks) may only bill you. When this happens, it becomes your responsibility to submit your claim to PacificSource for processing.
All claims for benefits must be turned in to PacificSource within 90 days of the date of service. If it is not possible to submit a claim within 90 days, turn in the claim with an explanation as soon as possible. In some cases PacificSource may accept the late claim. However, please be aware that they will not pay a claim that was submitted more than a year after the date of service.
You will need to register on the Health Information Portal to obtain copies of your receipts and statements to send to your insurance company for reimbursement.