Physician and Provider Manual

PacificSource Commercial Plans

The PacificSource Physician and Provider Manual is your desktop reference for information about PacificSource commercial policies and procedures. It can also be used as a training tool when familiarizing new employees to PacificSource. Updates are announced in The Provider Bulletin newsletter and on the For Providers - Welcome page of this website.

Please take a moment to look over the sections that relate to your responsibilities.  

If you have any questions or suggestions regarding this manual, you are welcome to contact your PacificSource Provider Service Representative.

Updates: Sections 3, 8, 9, and addenda updated January 2017.  

Complete Commercial Provider Manual with state-specific covered expenses, general exclusions, and limitations. 

For a faster download time and to easily find what you're looking for, you can also follow the links below to view a specific chapter of the Provider Manual.


Table of Contents

Section 1    Introduction

Section 2    Who to Contact

Section 3    Glossary of Terms (updated January 2017)

Section 4    Physicians and Providers 

Section 5    Referrals 

Section 6    Medical Management 

Section 7    Pharmacy 

Section 8    Products (updated January 2017)

Section 9    Members (updated January 2017)

Section 10    Filing Claims 

Section 11    Billing Requirements 

Section 12    Publications and Tools 


Idaho Covered Expenses, General Exclusions, and Limitations (updated January 2017)

Montana Covered Expenses, General Exclusions, and Limitations (updated January 2017)

Oregon Covered Expenses, General Exclusions, and Limitations (updated January 2017)

InTouch for Providers

Access your PacificSource account information 24/7.

Medicaid Dental Providers

Learn more about our contracted dental provider networks for Medicaid dental services.

Learn more >

Manuals for Our Government Plans

The PacificSource provider manual linked from this page is for our commercial health plans only. We have separate manuals for our government lines of business. Below are links to the web pages where you can access those manuals.

Medicare Provider Manual

Medicaid Provider Manual

Questions About the NPI?

We've put together a Frequently Asked Questions  sheet to better explain the purpose of your National Provider Identifier (NPI). If you've not done so, please forward your NPI to us at

Last updated 1/30/2017