Covered Services
CareSource covers the same services as traditional fee-for-service Medicaid. In addition, we cover some adult chiropractic care and private, adult outpatient psychology services. Our members do not have co-payments for medical services.
Members can get many services without a referral from their Primary Care Provider (PCP). They can simply call for an appointment. For more information, please click on No Referral Required.
Members must get a referral from their PCP to receive some services. A few services require both a PCP referral and Prior Authorization from CareSource. For more information, please click on Prior Authorization Required.
For more information about referral procedures, Prior Authorizations, and covered services, including a full Covered Services and Exclusions Grid, please see the Provider Manual.
No referral required
Some health care services provided by specialists do not require a referral from a Primary Care Provider. Members may schedule self-referred services from participating providers themselves. PCPs do not need to arrange or approve these services for members as long as any applicable benefit limits have not been exhausted. These include the following:
- Certified Nurse Midwife (CNM) services
- Certified Nurse Practitioner (CNP) services
- Chiropractic care (within benefit limits)
- Dental care (excluding oral surgery and orthodontics), see Dental Handbook
- Services to treat an emergency
- Family planning services (Planned Parenthood)
- Laboratory services (must be ordered by a participating provider)
- Podiatric care
- Psychiatric care at community mental health centers only
- Psychological care (from private practitioners or at community mental health centers)
- Care at public health clinics
- Care at Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs)
- Radiology services (must be ordered by a participating provider)
- Routine eye exams (at participating vision centers)
- Speech and hearing services
- Care from Obstetricians and Gynecologists
- Care at urgent care centers after hours
Please note that members may go to non-participating providers for:
- Emergency care
- Care at community mental health centers
- Family planning services provided at Qualified Family Planning providers (Planned Parenthood)
- Care at Federally Qualified Health Centers (FQHCs) and Rural Health Clinics (RHCs)
- Care at Ohio Department of Alcohol and Drug Addiction Services facilities that are Medicaid providers
Additional services
CareSource offers its members many benefits and support services. These include:
New Member Kits
Each new member household receives a New Member Kit upon enrollment in CareSource. This kit contains:
- A Member Handbook that explains plan services and benefits and how to access them
- A current Provider Directory that lists health care providers and facilities participating with CareSource
- CareSource's Notice of Privacy Practices as required by the Health Insurance Portability and Accountability Act (HIPAA)
- Other preventive health education materials and information
Each new member household receives an ID card and a New Member Kit upon enrollment in CareSource.
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.
Members can call the advice line at 1-866-206-0554.
Transportation
Transportation can be provided for member medical appointments with participating providers through CareSource's transportation vendors. Members can also get rides to Women, Infants and Children (WIC) appointments and redetermination meetings at the County Department of Job and Family Services. Each member can get up to 15 rides to and from appointments (30 one-way trips) per 12-month period.
Babies First
Pregnant members and new mothers can earn up to $150 in gift certificates to local stores by receiving recommended prenatal care for themselves and preventive services for their child. Members and providers can obtain Babies First brochures and coupons from CareSource.
If you provide OB or preventive services to CareSource members, you may be asked to validate coupons by completing information on the back of the coupon once the member has received the service. Please call us if you would like a supply of Babies First coupons for your office.
Interpreter services
CareSource offers sign and language interpreters for members who are hearing impaired, visually impaired, do not speak English, or have limited English-speaking ability. These services are available at no cost to the member.
CareSource requires hospitals, at their own expense, to offer sign and language interpreters for members who are hearing impaired, visually impaired or have limited English-speaking ability. As a provider for Medicaid consumers, you are required to identify the need for interpreter services for your CareSource patients and offer assistance to them appropriately. If you do not have access to interpreter services, contact Provider Services at 1-800-488-0134 (TTY: 1-800-750-0750 or 711).
We ask that you let us know of members in need of interpreter services as well as any members that may receive interpreter services through another source.