Credentialing

Providers who wish to contract with CareSource must first be credentialed. Through credentialing, CareSource checks the qualifications and performance of physicians and other health care practitioners. Providers are recredentialed a minimum of every three years and are considered to be recredentialed unless otherwise notified. 

CareSource credentials providers using guidelines from the Ohio Department of Job and Family Services (ODJFS), the National Committee for Quality Assurance (NCQA) and URAC. Our Vice President/Senior Medical Director is responsible for the credentialing and recredentialing program. 

House Bill 125/Ohio Revised Code Chapter 3963 requires that you submit a complete Council for Affordable Quality Healthcare (CAQH) Application or CAQH Number and National Provider Identifier (NPI) number via one of three vehicles:

  • Email contract.implement@caresource.com
  • Fax to 937-396-3632
  • Certified mail with return receipt to:

    CareSource
    Attn: Contract Implementation Specialist
    P.O. Box 8738
    Dayton, OH 45401-8738

For more information about CAQH, please log on to the CAQH website or call CAQH at 1-888-599-1771.

It is essential that all documents are complete and current; otherwise, CareSource will discontinue the contracting and credentialing process in order to maintain compliance with House Bill 125/Ohio Revised Code Chapter 3963 requirements.

Please also include the following documents:

  • Malpractice Insurance Face Sheet
  • CLIA Certificate (if applicable)
  • Standard Care Agreement (if an Advanced Practice Nurse)

CareSource is a participating organization with CAQH. Please make sure that we have access to your provider application PRIOR TO SUBMITTING YOUR CAQH NUMBER as referenced above by:

  1. Logging onto CAQH utilizing your account information
  2. Selecting the Authorization Tab
  3. Making sure CareSource Ohio is listed as an authorized Health Plan
  4. If not, please check the Authorized box to add

For more information or questions about credentialing, call CareSource at 1-800-488-0134 and follow the prompts to be directed to one of our Credentialing staff.  We can research the status of the provider's application in the credentialing process or what documents might still be needed from the provider.  We can answer questions from providers and their staff related to the Credentialing process.

Or you can find more information about credentialing in our Provider Manual.