ProviderSource - PacificSource

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“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.
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ProviderSource - PacificSource

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