We contract with the clearinghouses below to transmit professional, institutional, and dental claims electronically. Our payor ID number is 93029. (Please note there is a different payor ID for PacificSource Administrators: 93031.)
You may use one of these clearinghouses, or any other. If you use a clearinghouse not listed below, your clearinghouse should forward your claims to one of our contracted clearinghouses.
To find out more, contact the clearinghouse directly, or get in touch with your PacificSource Provider Service Representative.
Availity (formerly HeW)
5555 Gate Pkwy, Suite 110
Jacksonville, FL 32256
Transactions: professional and institutional claims,
- Submit applicable HCFA or UB form.
- Make sure the print is dark, clear, and free of smudges.
- Use 10- to 12-point black or blue type.
- Make sure all information is aligned within the appropriate box.
- Include only information needed for that claim.
- Use only one code per service line.
- Circle any specific pertinent information.
- Include the diagnosis appropriate to the date of service in Box 21(1) (HCFA).
- Include any diagnosis corresponding to Box 21(1) in Box 24(E) (HCFA).
- Include your federal tax ID number in Box 25 (HCFA).
- Please be sure to include the NDC (National Drug Code).