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ProviderSource
PacificSource Health Plans Provider Newsletter • Winter 2010
In this issue...
SBA Is Now PacificSource
Administrators, Inc...................... 2
Important Information for
IPN Providers............................... 2
HEDIS Reporting.......................... 3
Free Prenatal Vitamin
Program....................................... 3
Tobacco Cessation and Weight
Management Programs.............. 3
New Large Employer Clients...... 4
PacificSource Performance
At a Glance................................... 4
Administrative News.................. 5
Who to Call Reference................ 6
PacificSource newsletters are provided
for general information only, and are
not to be used to determine benefits. If
you are insured by PacificSource, your
benefits are determined only by your
policy.
PacificSource to Acquire Clear One Health Plans
We are pleased to share the exciting news that we have signed an
agreement to acquire Clear One Health Plans, Inc. of Bend, Oregon. The
acquisition will bring together two strong, local companies committed
to providing affordable, quality healthcare to more people in the
communities we serve throughout the Northwest.
The completion of the transaction is subject to a number of customary
conditions, including approval from the Oregon Insurance Division,
the Center for Medicare & Medicaid Services, the Division of Medical
Assistance Programs, and then approval of Clear One shareholders.
We anticipate that the transaction could close in the second quarter of
2010. In the meantime, both PacificSource and Clear One will remain
separate companies and will conduct business as usual.
Many of you already do business with Clear One (formerly Clear
Choice Health Plans). Founded in 1995 in Central Oregon, Clear One
has evolved from the country’s first provider-owned and operated
Medicare Advantage plan into an independent regional health plan
serving the commercial and government sectors. Licensed in Oregon,
Idaho, Washington, Montana, and South Dakota, Clear One Health
Plans, Inc. is a holding company for three subsidiaries:
• Clear One Life and Health, providing group life, disability, dental,
vision, and voluntary benefits to members in Idaho, Montana,
Oregon, and Washington
• Central Oregon Individual Health Solutions (COIHS), an administrator
of the Oregon Health Plan for 26,800 Oregonians
• Trusteed Plans Service Corporation (TPSC), providing administrative
services to 46,400 people through self-funded employer groups,
associations, Taft-Hartley Trusts, and Chamber of Commerce plans
“This acquisition is an important step in our strategy of becoming the
leading community health plan in our markets,” said Ken Provencher,
President and CEO of PacificSource Health Plans. “Clear One has
strong Medicare and Medicaid membership in Oregon, and their
expertise in those areas will help us build on our strength in the
commercial insurance market. Both organizations operate under a
business model that emphasizes partnership, service excellence, a
regional approach, and personal relationships, and all our customers
can expect to benefit from those values going forward.”
Continued inside.
POS Reminder
PacificSource.com
The New Year brings lots of changes, such as renewed patient
deductibles and out-of-pocket expenses. Remember,
you can get real-time patient cost estimates through the POS
link under InTouch for Providers on our Web site. If you are
not already billing us electronically, you can also use this
POS link to submit claims to us directly. For more information,
please contact your Provider Service Representative.

“This acquisition is an important
step in our strategy of becoming the
leading community health plan in
our markets.”
~ Ken Provencher, President and CEO
PacificSource Health Plans
Clear One Health Plans, Continued from Page 1
What will happen between now and the anticipated acquisition in
second quarter of 2010?
• Please continue to send any Clear One member claims to Clear
One until further notice.
• The acquisition will not be final until all approvals are received and
closing has taken place, most likely in the second quarter of 2010.
• Clear One Health Plans will remain an independent corporation and
operations will continue to be separate from PacificSource.
• Your current contracts and reimbursements with PacificSource and
Clear One will remain the same.
We will continue to be proactive in sharing information with you as we
develop our business and integration plans and move toward the close of
this transaction. In the meantime, if you have questions, you are welcome
to contact us.
Select Benefit Administrators, Inc. (SBA) Is Now
PacificSource Administrators, Inc.
Select Benefit Administrators, Inc. (SBA) became PacificSource
Administrators, Inc. on January 1, 2010. PacificSource Health Plans
purchased SBA six years ago, and SBA has operated as a subsidiary
company since then, providing administrative services to employers who
choose to self-fund their employee health benefits. This name change will
better reflect the relationship between the two organizations.
New Claims Address
Please send PacificSource Administrators claims to PO Box 70088,
Eugene, OR 97401-0105 or fax to (503) 670-8263.
Payer ID Number for Electronic Claims
You can continue to use the existing SBA payer ID numbers you are
now using or use the PacificSource payer ID (93029). If you are not
already submitting claims electronically, we encourage you to do so.
The advantages of e-claims submission include faster reimbursements,
reduced administrative costs, and greater accuracy. Please contact your
Provider Service Representative for information on how to get started.
New member ID cards
Current SBA members received new ID cards in December showing the
new name, logo, and claims address. In most cases, member ID numbers
and group numbers remain the same.
New Web Site
The company’s new Web site address is tpa.PacificSource.com. You can
also continue to access claims information and more through InTouch for
Providers at PacificSource.com.
New E-mail Addresses
PacificSource Administrators employee e-mail addresses have changed to
@pacificsource.com. The first part of the address (first initial followed by
last name) remains the same.
You’ll continue to work with the same people and can expect to receive
friendly, helpful service under PacificSource Administrators.
Important Information for Idaho Physicians Network
(IPN) Providers
As you may know, PacificSource acquired Primary Health Plan, Inc. earlier
this year, and that transaction included an ownership share of Idaho
Physicians Network (IPN). As part of our operational integration in Idaho,
effective January 1, 2010, there are a few changes that will affect our
providers in Idaho.
2

Provider Networks in Idaho
PacificSource has begun using the IPN network
throughout Idaho as of January 1, 2010. In addition to
IPN, PacificSource will continue to use the BrightPath
network for our BrightIdea plans.
New Claims Address and Payer ID Number
Effective January 1, 2010, all claims from Idaho providers
should be sent to PacificSource as follows:
Electronic Claims: PacificSource Payer ID number 93029
Paper Claims: PO Box 7068, Eugene, OR 97401-0068
Your Provider Service Representative
In late 2009, PacificSource’s Provider Service
Representative in Idaho, Hilary Meek, transitioned to a
similar role within Idaho Physicians Network (IPN). Hilary
will continue to be your key contact for PacificSourcerelated
topics and can be reached at (208) 908-5805
or (888) 492-2875, ext. 3805, or by e-mail at hmeek@
pacificsource.com.
New Preauthorization List Includes Fewer Procedures
For Idaho providers, we are reducing the number of
medical services that require preauthorization. Our
medical services and pharmacy preauthorization lists are
posted on our Web site—PacificSource.com—under For
Providers > Claims Guidelines. The preauthorization lists
may also be accessed directly at the following address:
Pacificsource.com/provider/preauthorization.aspx.
Preauthorization Request Forms can be downloaded
from that Web address, or you may contact your Provider
Service Representative to request forms.
Our preauthorization list is subject to revision as we
review new technologies and standards of medical
practice. The list is not intended to suggest that all items
included are necessarily covered by benefits under the
member’s plan.
HEDIS Reporting to Help Improve
Healthcare Outcomes
In an ongoing effort to improve healthcare outcomes
in the communities we serve, we are participating in
Healthcare Effectiveness Data and Information Set
(HEDIS) 2010 reporting. We anticipate gaining the ability
to identify specific areas for improvement and to report
on quality to our employer groups. We also plan to share
aspects of the data with you to begin improvement
initiatives, monitor disease management, and increase
preventive care.
Beginning in late February 2010, a vendor contracted by
PacificSource may contact you to arrange a convenient
collection of specific patients’ medical record information.
Arrangements will be made to review records in the
office, or they can be submitted by fax or e-mail if
preferred.
You’ll receive more information by mail in advance of
the medical records request. We appreciate your support
during this important quality improvement initiative, and
for improving the health of our communities.
3
Free Prenatal Vitamin Program Supports
Healthy Babies
To promote healthy fetal development and optimize
healthy baby outcomes, we now offer a free prenatal
vitamin program, effective January 1, 2010. PacificSource
members that are pregnant can receive up to six months
of physician-prescribed prenatal vitamins via mail order
at no cost. (Copays and deductibles are waived.) The
member must have a pharmacy benefit to be eligible,
and other restrictions apply.
If you have a patient that would like to take advantage
of this benefit, simply complete and fax our Prenatal
Vitamin Home Delivery Order Form to Wellpartner
pharmacy. The form, which includes questions and
answers on the back, is available from the For Our
Members > Forms and Materials area of our Web site,
PacificSource.com, or by contacting our Pharmacy
Department at (800) 624-6052 ext. 3784 or (541) 225-3784.
Tobacco Cessation and Weight
Management Programs Available to
PacificSource Members
As you know, quitting tobacco and maintaining a healthy
weight are two of the most important things people can
do to reduce their risk of health problems. Yet for many,
doing one or both of these things is daunting.
Our award-winning tobacco cessation program, Free &
Clear Quit For Life, helps members kick the tobacco habit
with a proven combination of one-on-one support and
nicotine replacement therapy. (Free & Clear is available
to all members with medical coverage, except those with
Short Term Medical policies.)
To assist members who want to lose weight or maintain
a healthy weight, we offer a Lifestlye Improvement
Program through Health Manager, an online tool
powered by WebMD ® . The program, which includes
educational information, exercise planners, and meal
ideas, is accessible through InTouch for Members at
PacificSource.com.
If you have PacificSource patients who are struggling
with weight management or quitting tobacco,
we encourage you to talk to them about these
free programs. To learn more, please see our new
informational fliers at PacificSource.com under For
Providers > Forms and Materials.

New Large Employer Clients
To keep you informed of potential new patients, as well as
possible coverage changes for existing patients, we publicize
large employers that have recently enrolled with us.
Covered
Lives*
Effective October 1, 2009
Location
46 Umpqua Research Company Myrtle
Creek
61 Women’s Health Center of Southern
Oregon PC
Grants Pass
58 Whitewater Construction Eugene
115 JCK Restaurants, Inc. DBA Carl’s Jr. Eugene
100 Metro Overhead Door, Inc. Portland
49 Big Country RV, Inc. Bend
40 Clarke’s Sheet Metal, Inc. Eugene
50 High Desert Automotive Supply, Inc.
DBA Napa Auto Parts
44 Petersen Kolberg and Associates
DBA PKA Architects
Bend
Portland
52 Seventh Mountain Resort Bend
Covered
Lives*
Effective November 1, 2009
Location
52 Northwest Surgical Specialists, LLP Springfield
50 Highland Laboratories, Inc. Mt. Angel
128 Rosen Aviation, LLC Eugene
213 Performance Health Technology LTD Salem
60 Ehlers Construction, Inc. Eugene
69 Marshalls, Inc. Springfield
106 Healthco Information Systems Tualatin
64 AFP Systems, Inc. Tualatin
108 Yorke and Curtis, Inc. Beaverton
352 A and M Transport, Inc. Glendale
35 The Maren Corporation Eugene
Covered
Lives*
Effective December 1, 2009
64 Rainbow Valley Design and
Construction, Inc.
Location
Eugene
50 Daniel N Gordon PC Eugene
41 The Hasson Company Clackamas
57 Elcon Associates, Inc. Portland
44 Westside International Medicine PC Portland
112 Davies, Inc. Salem
43 Western Panel Manufacturing, Inc. Eugene
41 Ken Ware Chevrolet, Inc. OADA North Bend
PacificSource Performance
At a Glance - December ‘09
Enrollment
Total Enrollment: 207,149
Medical Members: 173,588
Dental Members: 66,406*
* This number includes members with dental only
as well as those that have both dental and medical
coverage with PacificSource.
Claims Processing
Actual Target
Turnaround
Time: 13 days 10 days
Accuracy: 97% 99%
Customer Service
Actual Target
Answer
Speed (seconds): 24 25
Abandonment
Rate: 2% 2%
Customer Satisfaction
Actual Target
Member
Satisfaction: 95% 95%
Provider
Satisfaction: 100% 95%
* Covered lives references the approximate total of
enrolled employees plus their enrolled dependents. Benefit
information is printed on the patient’s ID card. If you have any
questions, please feel free to contact our Customer Service
Department.
4

Administrative News & Important Reminders
Oregon Legislation Brings Changes to
Autorecovery Process
Prior to 2010, our process for collecting refunds varied
based on the terms of your provider contract. In some
cases refunds were autorecovered, and in others they
were requested in writing.
Effective January 1, 2010, Oregon Senate Bill 508 states
that providers must be provided a refund request in
writing 60 days prior to autorecovery. To comply with
the new law, our new policy will apply to all providers
and will override any contract language. Our new refund
policy is as follows:
1. We send you (the provider) an initial refund request.
2. 30 days from initial request: If we have not received
the refund, or if you have not contested the refund
within this timeframe, we will send a reminder (second
refund request).
3. 60 days after the initial request: If we have still not
received the refund, the overpayment will be autorecovered
on the next scheduled payment.
To contest a refund, PacificSource requires the use of our
Contested Refund Form, available on PacificSource.com
under For Providers > Forms and Materials. In addition
to the form, supporting documentation is required to
contest the refund. Examples of documentation include:
• A new primary EOP in cases where a primary insurance
payer decides to reprocess their claim
• Chart notes that support the original payment
• Preauthorization obtained, which allows the original
payment to stand
Telemedicine Coverage
Effective January 1, 2010, in accordance with Oregon
Senate Bill 24, we are now covering Telemedicine
services under all of our fully insured plans (except
Short Term Medical). Coverage for self-insured plans
(under PacificSource Administrators, Inc.) will vary. To
bill PacificSource for Telemedicine services, the following
codes will be accepted: 0188T, 0189T, G0406, G0407 and
G0408, plus any covered procedure code with a GT
modifier.
To determine coverage for any other code not listed here,
please contact your Provider Service Representative.
Guidelines for Using Modifier 25
Our policy for Modifier 25 states that if you provide
both a service/procedure and E&M (evaluation and
management) on the same day, they must be significant,
separate, and identifiable. Documentation must support
both services and show that the E&M was above and
beyond the service or procedure provided. Please include
a chart note for each service and confirm that the same
patient received both services.
Please note that when we receive a claim that includes
a preventive care charge and an office visit charge, the
claim will be pended while our Claims Research Analyst
reviews the attached chart notes.
5
If no notes are present, the charges for the office visit will
be processed as provider write-off with the explanation
code stating that allowable charges are limited to one
office or hospital visit per day, and that the patient is not
responsible for the difference.
Examples of when both charges would not be
appropriate:
• A patient who has a history of hypertension is
scheduled for a routine physical. You make brief
mention of the hypertension and re-fill the patient’s
prescription.
• During an annual gynecological exam, a patient
mentions that she is having hot flashes, and you order
blood work to check hormone level.
• A child is seen for a well-child checkup and you note
that he has an ear infection and prescribe antibiotics.
Examples of when both charges would be appropriate:
• A patient is scheduled for a routine physical with a
history of hypertension, and upon examination, you
discover that the patient’s blood pressure is extremely
high. The patient says he is having lightheadedness
and ringing in the ears. You take measures to reduce
the blood pressure and counsel the patient on how to
monitor the condition.
• During an annual gynecological exam, you find a lump
in a patient’s breast and order additional blood work
and radiological procedures. You also take additional
time to go over treatment options with the patient.
Board Certification Reminder for Oregon Providers
When submitting an application to PacificSource for
new physicians or nurse practitioners joining your
clinic, please remember to include board certification
information noted on page 2, section 4 of the Oregon
Practitioner Credentialing Application. If your new
practitioner is a new graduate or the certification is in
process or pending, please indicate that as well.
PacificSource has found board certification to be one
useful benchmark of quality and competency. As you
know, board certification is a nationally recognized
attestation of basic qualifications in one’s specialty. In
addition, industry standards increasingly emphasize it as
a prerequisite for providers’ health plan participation.
Please be aware that our Credentialing Committee
may consider loss of certification, repeated failure to
pass certifying exams, or other deficiencies as grounds
for not accepting an application for credentialing or
recredentialing.
Old Code Books? Consider
Donating Them.
If you have 2009 medical code books taking up
space in your office, why not put them to good
use? Check with your local college to see if they
have a program that might need these resources.
As you know, code books are expensive, and
in many cases students only need them for one
class, so purchasing them can be a burden.

PO Box 7068
Eugene OR 97401-0068
Not sure who to contact with questions? Just clip and save for easy reference.
PacificSource Customer Service
PacificSource Health Services
Phone: 541.684.5582 (Eugene) or 888.977.9299 (all other areas)
E-mail: cs@pacificsource.com; Fax 541.225.3631
• Questions about member benefits or eligibility
• Questions about the status of a specific claim or EOP
Phone: 541.684.5584 (Eugene) or 800.624.6052 (all other areas)
E-mail: healthservices@pacificsource.com; Fax 541.225-3625
• Requests for preauthorization and referral authorization
• Case management
PacificSource Administrators, Inc. (formerly Select Benefit Administrators, Inc. [SBA]) Claims
If the member ID card features the PacificSource Administrators logo, direct inquiries to 888.532.5332.
PacificSource Provider Service Representatives
Phone 541.684.5580 (Eugene) or 800.624.6052 (all other areas) E-mail: providernet@pacificsource.com; Fax 541.225.3643
Your Provider Service Representative is available to provide support and education to your office staff. Please feel free to contact
your representative any time you have an administrative question or wish to report a change in your practice (address, phone
number, name, tax ID number, open/closed practice status, etc.).
If your office is in:
Oregon Counties: Baker, Crook, Deschutes, Gilliam, Grant,
Harney, Jefferson, Klamath, Lake, Malheur, Morrow, Sherman,
Umatilla, Union, Wallowa, Wasco, and Wheeler
Oregon Counties: Coos, Curry, Douglas, Jackson, Josephine,
Lane
Washington Counties: Benton, Clark, Columbia, Cowlitz,
Franklin, Island, Kitsap, Klickitat, Lewis, Pacific, San Juan,
Wahkiakum, Walla Walla, Yakima. Oregon Counties: Clackamas,
Columbia, Hood River, Multnomah, Washington
Idaho Counties: All
Washington Counties: Asotin, Spokane, Whitman
Oregon Counties: Benton, Clatsop, Lane, Lincoln, Linn, Marion,
Polk, Tillamook, Yamhill
Your Service Representative is:
Michelle Cochran • mcochran@pacificsource.com
541.550.5678 / 800.624.6052, ext. 2678
Stephanie De Less • sdeless@pacificsource.com
541.684.5566 / 800.624.6052, ext. 5566
Renea DiDomenico • rdidomenico@pacificsource.com
503.802.5335 / 800.624.6052, ext. 5335
Hilary Meek • hmeek@pacificsource.com
208.908.5805 / 888.492.2875, ext. 3805
Debbie Smith • dsmith@pacificsource.com
541.684.5439 / 800.624.6052, ext. 5439