For charges incurred at the ²ÊºçƵµÀ College Health and Counseling (HCC):
- Log on to the
- Under Statements, select the date of service for the charges you would like to have sent to PacificSource (PS).
- Print the statement.
- Write your PS ID number on the statement.
- Submit the invoice to PS one of the following ways:
- Email: CS@PacificSource.com
- Fax: 541-225-3632
- Mail: PacificSource Health Plans, PO Box 7068, Springfield, OR 97475-0068 - The HCC has postage paid preaddressed envelopes.
Please keep a copy of the receipt for your records. PS is unable to return any documentation they receive.
The charge will remain on your ²ÊºçƵµÀ Student Account until the claim is processed at which time a check will be mailed to the business office. It is your responsibility to ensure ²ÊºçƵµÀ is paid for these charges.
For charges incurred elsewhere:
Follow the same instructions above but with a statement from the other provider. The statement must have the following information on it and it can be hand written:
- Member name and ID number
- Date of service
- Billed charges
- CPT or billing code
- Diagnosis code
- Provider name, address, phone number and Tax ID number.
- Proof of payment
For questions or concerns, please call PS at 888-977-9299, TTY 711 (PS accepts all relay calls), or email CS@PacificSource.com.