Provider Services

Why participate with CareSource?

A focus on preventive health care and personal service is core to CareSource's operating philosophy. For participating health care providers, we offer:

  • Enhanced reimbursement - CareSource offers a competitive reimbursement for its valued providers.
  • Claims call center - A call center dedicated to provider claims inquiries is staffed with claims experts for prompt issue resolution.
  • Web-based transactions and electronic claims submission - CareSource has the technology to support a variety of electronic transactions with participating providers.
  • 24-hour member eligibility verification - Member eligibility can be verified any time of the day or night online or through our automated phone system.
  • Paperless referral system - Hassle-free medical management and less paperwork mean more time to focus on patient care.
  • Commitment to service - We answer providers' questions quickly and accurately and offer orientations and in-service programs for providers and their office staff.
  • Member support services - CareSource can assist with patient compliance with services such as a 24-hour nurse advice line, case management and health education.

Learn more about how easy Credentialing is with CareSource.

Our services

CareSource's foundation is our strong partnership with our contracted health care providers. Through you, we fulfill our mission of making a difference in the lives of underserved people by improving their health care.

Because the satisfaction of our health care providers is so important to us, we offer a wide array of services and benefits, including:

Provider service center

How to reach us

Call Provider Services toll-free at 1-800-390-7102. Press the option for providers.

Our friendly and knowledgeable representatives are available to speak with you 8 a.m. to 5:30 p.m., Monday through Friday, except holidays. The menu options will also let you speak with people from our medical management, pharmacy, appeals and Provider Relations departments.

You can call the Provider Services with questions or issues about:

Please have the Michigan Medicaid or CareSource ID number for the member you are calling about ready when you call.

You may also call the Provider Services to:

  • Ask questions about your contract, claims, claim submission, checks, or Explanations of Payment (EOP)
  • Report possible fraud
  • Get help with electronic billing and other Electronic Data Interchange (EDI) issues

Please have your CareSource provider ID number ready when you call.

Enhanced reimbursement

CareSource offers a competitive reimbursement for its valued providers.

We also offer a performance bonus to Primary Care Providers for providing certain well-child checkups and immunizations.

For more information, please contact your Provider Relations representative.

Provider Portal

CareSource's secure online Provider Portal makes it easier for you to work with us. The portal is easy to access, whenever it is convenient for you. This helpful online tool is available for all CareSource health care plans. Assisting you is one of our top priorities in order to deliver better health outcomes for our members. If you are a registered user, or want to become one, please click on Provider Login to perform a variety of web-based transactions such as:

  • Claims Status
  • Member Eligibility
  • Coordination of Benefits (COB)
  • Provider Relations

Do you have a question about your contract with CareSource? Do you need help with credentialing? Would you like us to conduct an orientation for your office? Has your practice moved or added a new Provider? Do you have an issue with reimbursement?

Whatever the question, our Provider Relations department is here to serve you. Just call Provider Services at 1-800-390-7102. Ask to speak with the Provider Relations representative for your area.

You can also send an email to CSMIProviderRelation@caresource.com or send a fax to 1-866-927-5566. 

Below is a list of Provider Relations representatives:

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Provider Relations representatives

Electronic claims submission

CareSource has invested in an EDI system to enhance our service to participating providers. Our EDI system complies with HIPAA standards for electronic claims forms. We are committed to offering you the most flexible and efficient means possible of doing business with us.

CareSource accepts electronic claims in the following file format:
837 ANSI ASC x 12N (004010A1), hospital or professional.

To submit claims electronically, providers must work with an electronic claims clearinghouse. CareSource currently accepts electronic claims through Emdeon (formerly known as WebMD) and Netwerkes.

For more information about how to submit an electronic claim, please see Electronic Claims.

Appeals procedures

Medical Necessity Appeals of Non-Certification Determinations: Member, Provider or Provider Appealing on Behalf of a Member Standard Medical Necessity Appeals of Non-Certification Determinations

An appeal is defined as a formal request by a member or provider, including facilities or other health care entities on behalf of a member or provider for a review of a determination or action. Medical necessity appeals of non-certification determinations must be submitted to CareSource within 90 calendar days after the date of the denial letter by the member or provider. Medical necessity appeals filed by members or providers on behalf of a member with written authorization to appeal on their behalf in writing will be resolved within 15 calendar days of receipt or as expeditiously as the Member's condition warrants. All other medical necessity appeals will be resolved within 30 calendar days of receipt. Please see the Provider Manual for more about Appeals Procedures. 

CareSource 24

Experienced registered nurses are available 24 hours a day, 7 days a week to provide symptom-based triage and health education to CareSource members.

Health care counseling and telephone triage helps assess health status and provides immediate health information, guiding members to the appropriate level of care. Members can then be referred or routed to other CareSource services that may be beneficial to them. This coordination between CareSource departments helps maintain continuity of care.

Our nurses help Members:

  • Decide when self-care, a doctor visit or the emergency room is appropriate
  • Understand a medical condition or recent diagnosis
  • Prepare questions for doctor visits
  • Find out more about prescriptions or over-the-counter medicines
  • Get information on diagnostic or surgical procedures
  • Learn about nutrition and wellness

Members can call CareSource 24 at 1-866-206-0488.

Case management

CareSource provides the services of case management through Health Coaches who are nurses or social workers to provide one-on-one, personal interaction with members.  Case management activities support the Primary Care Physician (or treating physician) and member to improve the overall health and quality of life of the member. 

Our focus is on helping our members acquire and maintain effective management of their condition through assessment, coordination of care, education and support.

Our case management program focuses on members with:

  • Special health care needs
  • Asthma 
  • Diabetes
  • Congestive heart failure
  • Pain Management
  • Pregnancy
  • Weight Management

We work in partnership with you to encourage compliance with treatment plans, reinforce medical instructions and assess social needs. Please contact us if you identify a CareSource member who may benefit from case management.

Please see Additional Services for information about the other member support services CareSource offers.