Forms and Materials for Our Providers

Click on a specific form below to download and print a current version.

Administrative Forms

Informational Fliers and Guides

Preauthorization Checklists

Contracting and Participation Forms

InTouch for Providers

Access your PacificSource account information 24/7.

Medicaid Dental Providers

Learn more about our contracted dental provider networks for Medicaid dental services.

Learn more >

Interested in contracting with PacificSource outside of Oregon, Idaho, and Montana?

Please use the following network nomination forms:

FirstChoice Network Nomination

First Health Network Nomination

BrightPath Network Nomination

IPN Network Nomination

Advantage Dental Network Nomination

Last updated 6/28/2018