Check Member Eligibility

The CareSource ID card is used to identify CareSource members. The ID card does not verify eligibility for benefits since members may disenroll from CareSource and retain an old card.

Therefore, it is important to verify member eligibility before providing services. Patients must be eligible CareSource members at the time of service in order for services to be covered.

Verify Member Eligibility:

Online: Provider Portal

  • You can check CareSource member eligibility up to 12 months after the date of service. You can search by date of service plus any one of the following:
    • Member name and date of birth
    • Case number
    • Medicaid number
    • CareSource member ID number

Call: 1-800-488-0134. Our automated member eligibility verification system can be reached 24 hours a day from any touch tone phone.

  • PCPs only: Check the monthly member eligibility list. Primary Care Providers (PCPs) receive a member eligibility list at the beginning of each month.

    The list contains the names of eligible members assigned to the PCP. It also includes date of birth and notification of patients due for a Healthchek exam. PCPs can also download this list from the secured area of our website.

Providers should always verify member eligibility before rendering services except in an emergency. It is important to verify that CareSource members are eligible for care on the date of service. This helps prevent denied claims.

Newborn enrollment

Newborns whose mothers are members of our health plan are covered from the date of birth. In most cases, the newborn's name will appear on the PCP's member eligibility list for the month following the birth. Please contact Provider Services to verify eligibility. Please note: the mother must contact their county caseworker as soon as possible to establish eligibility for their baby.