To support faster and more consistent resolution of claim payment concerns, a new dedicated Provider Payment Dispute (PPD) process should be used when you believe a claim has been paid incorrectly. The new PPD process, effective November 1, 2026, applies to both contracted and non-contracted providers submitting disputes related to commercial, Medicare Advantage, or Medicaid claims.
What’s new
- A new standardized Provider Payment Dispute Request Form is now available to streamline dispute submissions.
- A dedicated fax number has been established for provider payment dispute submissions.
Why we’re making this change
This new process will help us address payment concerns more promptly and efficiently. Using a dedicated form and fax line helps ensure disputes are routed to the appropriate team more quickly, reducing delays and improving communication throughout the review process.
What you need to know
Beginning November 1, 2026, the Provider Payment Dispute Request Form will be required for all provider dispute submissions. Complete the Provider Payment Dispute Request Form in full, attach all required supporting documentation, and fax it to our new dedicated PPD fax line: 541-225-1901.
Submit a separate Provider Payment Dispute Request Form for each disputed claim to ensure accurate intake, tracking, and resolution.
What you should do
Please use the new Provider Payment Dispute Request Form if the claim was submitted correctly and:
- You disagree with the payment amount
- You believe the claim was denied in error
- You believe the claim was processed incorrectly
Do not use this form for:
- Appeals: Disputes involving medical necessity, authorization, or coverage determinations.
- Corrected claims: Billing errors, including incorrect codes, date of service, or modifiers.
Questions?
For common questions about the new Provider Payment Dispute process, please review the Provider Payment Dispute FAQ or contact your Provider Relations Representative.
PacificSource Health Plans | PacificSource Community Health Plans (Medicare) | PacificSource Community Solutions (Medicaid)