Covered Services
CareSource covers the same services as traditional fee-for-service Medicaid. Our members do not have co-payments for medical services or prescription drugs.
Members can get many services with no referral required from their Primary Care Provider (PCP). They can simply call for an appointment.
Some services require a referral from the Primary Care Provider, Prior Authorization from CareSource, or both.
CareSource members also receive many other benefits. These include a service center, a 24-hour nurse triage line, and transportation to medical appointments. For more information about referral procedures, Prior Authorizations, and covered services, please visit the Prior Authorization section or the Covered Services Grid.
CareSource uses a Pharmacy Benefits Manager. With pharmacy coordinators on staff to help facilitate services, we pair a clinically sound Preferred Drug List (PDL) with a wide network of participating pharmacies.
For more information, please call Provider Services at 1-800-390-7102.
When a Referral is Not Required
Some health care services provided by specialists do not require a referral from a Primary Care Provider. Members may schedule self-referred services from participating providers as long as any applicable benefit limits have not been exhausted.
Services that Do Not Require a Referral:
- Certified Nurse Midwife (CNM) services
- Chiropractic care (within benefit limits)
- Services to treat an emergency
- Family planning services (Planned Parenthood)
- Laboratory services (must be ordered by a participating provider)
- Podiatric care
- Care at public health clinics
- Care at Federally Qualified Health Centers (FQHCs)
- Radiology services except for MRI (must be ordered by participating provider)
- Routine eye exams (at participating vision centers)
- Hearing services
- Care from obstetricians and gynecologists
- Care at urgent care centers after hours
Members may go to Non-Participating Providers for:
- Emergency care
- Family planning services at Qualified Family Planning providers
- Care at FQHCs
For more information, please call Provider Services at 1-800-390-7102 or visit the Provider Manual.
When a Referral is Required
CareSource members must get a referral from their Primary Care Provider or specialist to receive some services.
Services that Require Referral:
- Specialist services - This includes visits to most participating specialists, such as a cardiologist or a certified nurse midwife. Specialists are listed in the Provider Directory
- Medical supplies - These require a prescription. They include diabetic supplies, surgical dressings, splints, casts and other items that cannot be reused. For more information, please see Prior Authorization
- Diagnostic services - This includes X-rays and lab work
- End-stage renal disease services
- Dental surgery in a hospital setting
- Laparoscopy, tubal cautery
- Sleep studies
- Vasectomy
Additional Services
CareSource offers its members many benefits and support services. For additional questions regarding benefits, call 1-800-390-7102 from 8 a.m. to 5:30 p.m. These include:
CareSource 24
CareSource offers an in-house, 24-hour nurse triage line for Members to call with medical questions and concerns 24 hours a day, 7 days a week. Our nurses can assess a Member's condition and direct the Member to the most appropriate place for care, whether that is the doctor's office, urgent treatment center or the emergency room. Members can call CareSource 24 at 1-866-206-0488.
Transportation
Transportation can be provided for member medical appointments with participating providers through CareSource's Transportation Services. Members can request transportation by calling 1-800-390-7102.
Case Management
CareSource has nurse case managers who assist members with conditions such as asthma, diabetes, congestive heart failure, obesity and high-risk pregnancy in coordinating appropriate medical and support services. If you know of any CareSource member who may benefit from case management, please call Member Services at 1-800-390-7102.
Interpreter Services
CareSource offers sign and language interpreters for members who are hearing impaired, visually impaired, do not speak English, or have limited English-speaking ability. These services are available at no cost to members or health care providers.
As a provider for Medicaid consumers, you are required to identify the need for interpreter services for your CareSource patients and offer assistance to them appropriately. To arrange services, please contact Member Services at 1-800-390-7102.
Vision Services
For all vision services including eye exams, CareSource members should contact Vision Services Plan (VSP) at 1-800-877-7195.
Mental Health Services
For all mental health services including routine, urgent and emergency care, CareSource members should call Comprehensive Behavioral Care at 1-800-435-5348. They will be referred to an appropriate mental health care provider.
For more information, please call Member Services at 1-800-390-7102 or visit the Provider Manual.
Services Outside CareSource
CareSource does not cover some services, but Members can still receive them through Michigan Medicaid or another agency.
These services are:
- Dental care - Dental care is covered by Medicaid Fee-For-Service
- Custodial long-term care in a nursing home
- Certain anti-psychotic and anti-retroviral drugs - These are covered by Michigan's pharmacy benefits manager First Health at the point of sale. Members should present their MiHealth card
- WIC services - This is a food and nutrition program for women, infants and children. Call your local health department
- Services for people with developmental disabilities - Call your local community mental health agency
- Drug and alcohol abuse services - Call your local substance abuse coordinating agency
For help in locating an agency, please call Provider Services at 1-800-390-7102.
Services Not Covered
If you have questions regarding services not covered, please call Provider Services at 1-800-390-7102.