Denials, appeals and grievances

Find appeal teams, faxes and mailing addresses. Use the denial notice to confirm the appeal level, filing deadline and recipient.

fax appeals

Provider appeals — commercial (Appeal and Grievance Department)

Official page read

Phone

No phone listed for this route

Fax

541-225-3628

Published hours

Not published in this record

Product, plan and location

commercial
Oregon · Idaho · Montana · Washington

Mailing address

PacificSource Health Plans Appeal and Grievance Department P.O. Box 7068 Springfield, OR 97475-0068

Provider appeals.

Mail or fax the commercial Provider Appeal Form within 180 days of the denial; InTouch (via OneHealthPort) is the preferred route. Do not use for corrected or duplicate claims.

View source ↗ · Source checked 2026-10-25 · Provider appeals page linking the commercial appeal form ↗

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Find appeal teams, faxes and mailing addresses. Use the denial notice to confirm the appeal level, filing deadline and recipient.

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Denial notice, remittance and reason codes
Previous appeal confirmation and decision
Supporting evidence and any required authorization to represent the member

Questions to resolve

Is this a claim correction, provider dispute or member appeal?
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