Provider Services

Why participate with CareSource?

A focus on preventive health care and personal service is core to CareSource's operating philosophy. For participating health care providers, we offer:

  • Enhanced reimbursement - CareSource offers a competitive reimbursement for its valued providers.
  • Claims call center - A call center dedicated to provider claims inquiries is staffed with claims experts for prompt issue resolution.
  • Web-based transactions and electronic claims submission - CareSource has the technology to support a variety of electronic transactions with participating providers.
  • 24-hour member eligibility verification - Member eligibility can be verified any time of the day or night online or through our automated phone system or on our secure provider portal.
  • Paperless referral system - Hassle-free medical management and less paperwork mean more time to focus on patient care.
  • Commitment to service - We answer providers' questions quickly and accurately and offer orientations and in-service programs for providers and their office staff.
  • Member support services - CareSource can assist with patient compliance with services such as a 24-hour nurse advice line, case management and health education.

Learn more about how easy Credentialing is with CareSource.

  • Our Services
  • Request a New Contract with CareSource
  • Provider Information Change
  • Provider Service Center
  • Provider Portal
  • Provider Relations
  • Our Services

    CareSource's foundation is our strong partnership with our contracted health care providers. Through you, we fulfill our mission of making a difference in the lives of underserved people by improving their health care.

    Because the satisfaction of our health care providers is so important to us, we offer a wide array of services and benefits including quick claims payment, enhanced reimbursement, a secure provider portal available 24/7 and more.

    Request a New Contract with CareSource

    Providers who would like to set up a new contract with CareSource should send a completed New Contract Provider Information Form and a copy of your W-9:

    Email: newcontract@caresource.com
    Fax: 937-396-3290
    Mail: CareSource
    PO Box 8738
    Dayton, OH 45401-8738
    Attn: New Contract

    Provider Information Change

    Advance written notice of status changes, such as a change in address, phone, or adding or deleting a provider to your practice help us keep our records current and are critical for claims processing.

    How to Submit Changes to CareSource

    Please complete the Provider/Group Change Request Form and submit to CareSource:

    Timeline of Changes:

     Type of Change  Minimum Notice Required
     New providers or deleting providers*  Immediate
     Phone number change  10 calendar days
     Address change  60 calendar days
     Providers leave the practice  60 calendar days
     Change in capacity to accept members  60 calendar days

    Why is this Important?

    This information is critical to process your claims. In addition, it ensures our directories are up-to-date, and reduces unnecessary calls to your practice. This information is also reportable to Medicaid and Medicare.

    *A claim submitted after May 23, 2007, for a deceased provider who had an NPI will be rejected by Medicare because the provider's NPI was deactivated in the Medicare claims processing system due to the provider's death. For more information, visit CMS.gov.

    Provider Service Center

    How to reach us

    Call Provider Services toll-free at 1-800-488-0134 and follow the prompts.

    Our friendly and knowledgeable representatives are available to speak with you from 8 a.m. to 6 p.m., Monday through Friday, except holidays.

    You can call Provider Services with questions or issues about covered services, procedures or services that require Prior Authorizations, member eligibility, basic reimbursement rate inquiries and other CareSource policies. Please have the name and CareSource member ID number for the member you are calling about ready when you call.

    For more information, please contact your Provider Relations Representative.

    Provider Portal

    CareSource's secure online Provider Portal makes it easier for you to work with us. The portal is easy to access, whenever it is convenient for you. This helpful online tool is available for all CareSource health care plans. Assisting you is one of our top priorities in order to deliver better health outcomes for our members. If you are a registered user, or want to become one, please click on the Provider Login to perform a variety of web-based transactions such as:

    • Claims Status
    • Member Eligibility
    • Prior Authorizations (medical only)
    • Member Profile
    • Member Rosters
    • CareSource Clinical Practice Registry

    Provider Relations

    Interested in becoming a participating health care provider? Do you have a question about your contract with CareSource? Would you like us to conduct an orientation for your office? Do you have a reimbursement issue?

    Whatever the question, our Provider Relations Department is here to serve you. Just call Provider Services at 1-800-488-0134. Ask to speak with the Provider Relations Representative assigned to you.