Covered Services
CareSource covers the same services as traditional fee-for-service Medicaid. Our members do not have co-payments for medical services. In addition to traditional benefits, we cover some adult chiropractic care and private, adult outpatient psychology 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 visit the section No Referral Required.
Members must receive a Prior Authorization from their PCP to receive some services. For more information, please visit the Prior Authorization section. Also, our Covered Services Grid indicates which services require Prior Authorization.
For additional questions, please see the Provider Manual.
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)
- 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. For additional questions regarding benefits, call 1-800-488-0134 from 8 a.m. to 6 p.m. These include:
CareSource 24
CareSource offers an in-house, 24-hour nurse triage line for Members to call with medical questions and concerns 24 hours a day, 7 days a week. Our nurses can assess a Member's condition and direct the Member to the most appropriate place for care, whether that is the doctor's office, urgent treatment center, or the emergency room. Members can call CareSource 24 at 1-866-206-0554.
Case Management
CareSource has nurse case managers who assist members with conditions such as asthma, diabetes, congestive heart failure, obesity and high-risk pregnancy in coordinating appropriate medical and support services. If you know of any CareSource member who may benefit from case management, please call Member Services at 1-800-488-0134.
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 receive 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 members receiving 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).
Services Not Covered
If you have questions regarding services not covered, please call Provider Services at 1-800-488-0134.