Pacificsource Corrected Claim Form
What makes the 5412253634 legally binding?
Because the world ditches in-office work, the execution of paperwork more and more occurs online. The pacificsource corrected claim form isn’t an any different. Working with it utilizing digital means differs from doing so in the physical world.
An eDocument can be viewed as legally binding provided that certain needs are fulfilled. They are especially crucial when it comes to stipulations and signatures associated with them. Entering your initials or full name alone will not guarantee that the institution requesting the form or a court would consider it executed. You need a reliable tool, like airSlate SignNow that provides a signer with a digital certificate. In addition to that, airSlate SignNow keeps compliance with ESIGN, UETA, and eIDAS - main legal frameworks for eSignatures.
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Compliance with eSignature laws is only a portion of what airSlate SignNow can offer to make document execution legal and secure. Furthermore, it offers a lot of opportunities for smooth completion security smart. Let's quickly go through them so that you can stay assured that your pacificsource corrected claim form remains protected as you fill it out.
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Handy tips for filling out 5412253634 online
Quick steps to complete and e-sign Pacificsource Corrected Claim Form online:
- Use Get Form or simply click on the template preview to open it in the editor.
- Start completing the fillable fields and carefully type in required information.
- Use the Cross or Check marks in the top toolbar to select your answers in the list boxes.
- Utilize the Circle icon for other Yes/No questions.
- Look through the document several times and make sure that all fields are completed with the correct information.
- Insert the current Date with the corresponding icon.
- Add a legally-binding e-signature. Go to Sign -> Add New Signature and select the option you prefer: type, draw, or upload an image of your handwritten signature and place it where you need it.
- Finish filling out the form with the Done button.
- Download your copy, save it to the cloud, print it, or share it right from the editor.
- Check the Help section and contact our Support team if you run into any problems when using the editor.
We know how stressing filling in documents can be. Obtain access to a GDPR and HIPAA compliant platform for optimum straightforwardness. Use airSlate SignNow to electronically sign and send out Pacificsource Corrected Claim Form for e-signing.
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People also ask
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Is PacificSource the same as OHP?
In Oregon, Medicaid is called the Oregon Health Plan, or “OHP,” and is run by the Oregon Health Authority. In specific regions in Oregon, PacificSource Community Solutions coordinates your care and manages your OHP benefits. -
How do I indicate a corrected claim on 1500?
On the CMS-1500 Form, use Corrected Claim Indicator (Medicaid Resubmission Code). Enter the frequency code "7" in the "Code" field and the original claim number in the "Original Ref No." field. -
What is a claim correction?
What is a corrected claim? A corrected claim is a replacement of a previously submitted claim (e.g., changes or corrections to charges, clinical or procedure codes, dates of service, member information, etc.). -
Who is po box 7068 springfield or 97475 0068?
PacificSource Health Plans Attn: Claims Department PO Box 7068 Springfield OR 97475-0068. -
What is the payer ID for PacificSource Medicare Advantage?
We contract with the clearinghouses listed below to provide transmission of professional and institutional electronically; our payor ID number is 20377. -
What is Pacific Source Commercial Payer ID?
Our Payor ID number is 93031. -
What is the phone number for Pacific Source Insurance OHP?
800-431-4135, TTY: 711. -
What code do you use for a corrected claim?
Professional Claims If you are submitting a void/replacement paper CMS 1500 claim, please complete box 22. For replacement or corrected claim enter resubmission code 7 in the left side of item 22 and enter the original claim number of the claim you are replacing in the right side of item 22.
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