Claims Payment Appeals

Providers may appeal claims payment denials within 365 days from date of service. Claims payment appeals should include:

  • Member's name and identifying information
  • Claim number
  • The service for which payment was denied
  • Date(s) of service
  • The reason CareSource's decision to deny payment should be reconsidered
  • Any clinical notes or other medical information to support your request

When submitting an appeal for a claim dispute it's important to send the clinical notes. In order to conduct a thorough review, CareSource needs all the pertinent clinical information to make the appropriate determination of the claim.

We will notify you of a decision within 30 days, and any needed adjustments will be made to a future payment.

Claims appeals should be addressed to:

CareSource
Attn: Provider Appeals
P.O. Box 2008
Dayton, OH 45401-2008