Check Member Eligibility

The CareSource ID card is used to identify CareSource members, however, it does not verify eligibility for benefits since members may disenroll from CareSource and retain an old card. Therefore, it is important to verify member eligibility before providing services. Patients must be eligible CareSource members at the time of service in order for services to be covered.

To verify member eligibility, please use one of the following methods:

• Click on Provider Login and register to use the secured area of our website. You can check CareSource member eligibility up to 12 months after the date of service. You can search by date of service plus any one of the following:
  • Member name and date of birth
  • Case number
  • Medicaid number
  • CareSource member ID number
• PCPs only: Check the monthly member eligibility list. Primary Care Providers (PCPs) receive a member eligibility list at the beginning of each month. The list contains the names of eligible members assigned to the PCP. It also includes other important information such as date of birth and indicators for patients who are due for a Healthchek exam. Whenever members seek care from the PCP, their eligibility can be verified by checking the current month's list. PCPs can also download this list from the secured area of our website. If the patient is not on the list, please call Provider Services.
• Use our automated phone system. Call 1-800-488-0134. Our automated member eligibility verification system can be reached 24 hours a day from any touch tone phone. Just follow the appropriate menu options. The automated system will prompt you to enter the member ID number and the month of service to check eligibility.
• You can check member eligibility status by going to Provider Login or you may check the IVR system. 

Providers should always verify member eligibility before rendering services except in an emergency. It is important to verify that CareSource members are eligible for care on the date of service. This helps prevent denied claims.

Newborn enrollment

Newborns whose mothers are members of our health plan are covered from the date of birth. In most cases, the newborn's name will appear on the PCP's member eligibility list for the month following the birth. The automated eligibility verification system is not recommended for verifying the status of newborns due to possible information processing delays. Please contact a Provider Services representative instead. Please note the mother must contact their county caseworker as      soon as possible to establish eligibility for their baby.

For more information about member eligibility, please refer to the Member Enrollment and Eligibility section of the Provider Manual.