Member Billing Policy
State and federal regulations prohibit health care providers from billing Medicaid consumers for covered services provided to them. CareSource monitors this activity based on reports of billing from members.
Please note: CareSource covers Medicaid co-payments for its members. No CareSource member should be charged a co-payment for any type of Medicaid service.
Covered services
Regulations state that health care providers must hold members harmless if CareSource does not pay for a covered service performed by the provider, unless CareSource denies Prior Authorization of the service and the provider tells the member in writing that the member is financially responsible.
This must be done prior to rendering the service, and the member must sign and date the notification.
Non-covered services
If the CareSource member requests a service not covered by Medicaid, providers may charge the member for the service as long as the member has been told prior to rendering the service that it was not covered.
If the provider does not tell the member that the service is not covered until after it has been rendered, the provider cannot bill the member.
Missed appointments
State and federal policy also prohibits health care providers from billing Medicaid consumers for missed appointments. This includes CareSource members.
CareSource provides transportation to help ensure that our members make it to needed medical appointments.
Please call our Case Management Department if you are concerned about a CareSource member who misses appointments. We can assist you with education and follow-up.
For more information, please call the Provider Services at 1-800-390-7102 or see the Provider Manual.