Member Billing Policy

State and federal regulations prohibit health care providers from billing Medicaid consumers for services provided to them. CareSource monitors this activity based on reports of billing from members.

Please be aware that CareSource will cover all co-payments for its members. No CareSource member should be charged a co-payment for any type of 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. Please refer to the Michigan Medicaid Provider Manual, section 9.

Missed appointments

State and federal policy also prohibits health care providers from billing Medicaid consumers for missed appointments. This includes CareSource members.

CareSource encourages members to keep scheduled appointments and call to cancel if necessary. We also provide transportation to help ensure that our members make it to needed medical appointments.

Please feel free to 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.