Directory information — verify before you send. This fax number was compiled by automated research from public sources. It may be out of date, incomplete, incorrect, or in rare cases wrong entirely, and it is not confirmed by PacificSource Health Plans. Before sending anything sensitive, confirm the number and receiving department directly with PacificSource Health Plans, and consider sending a test cover page first. FaxFlow is an independent directory, is not affiliated with, endorsed by, or sponsored by this organization, and accepts no liability for reliance on this listing.
This appears to be a financial, insurance, or legal destination. Documents sent here may contain account numbers, SSNs, or privileged information. Confirm the current number and department directly with the organization before sending, and keep your transmission confirmation.
Represent PacificSource Health Plans? Request a correction or removal. By using this directory you agree to our Fax Directory Terms.
PacificSource Health Plans fax number
(541) 225-3628
Wrong or outdated? Report this number
Grievance Review
Used for: Grievances and Appeals submissions; designation of Authorized Representative for pursuing benefit determinations; used to file grievances/appeals and authorize another person to act on your behalf.
Fax destination details
- Department
- Grievance Review
- Purpose
- Grievances and Appeals submissions; designation of Authorized Representative for pursuing benefit determinations; used to file grievances/appeals and authorize another person to act on your behalf.
- Form
- Designation of Authorized Representative Form — Designation of Authorized Representative Form
- Address
- PO Box 7068, Springfield, OR 97475-0068
- Voice phone
- 888-977-9299
- Website
- Visit organization website
Before you send
- Confirm that this exact department handles your document or request.
- Check the organization website or call its main line for the current fax number.
- Include a cover sheet and any case, member, claim, or form reference required.
- Keep the delivery confirmation with your submission records.
Fill member information, designate the authorized representative, sign and date, then mail to PacificSource Health Plans Attn: Grievance Review PO Box 7068 Springfield, OR 97475-0068 or fax to 541-225-3628. For questions call 888-977-9299 (TTY: 711).
Review official form instructionsSources and verification
FaxFlow records the public sources found during directory research. A source link is useful evidence, but it is not a guarantee that a number still reaches the same team.
No public source link was saved with this record. Confirm the number directly with the organization before using it.