CareSource Compliance Snapshot
CareSource is proud to implement a corporate compliance plan that stresses personal, professional, ethical, and legal standards. The compliance plan and code of conduct demonstrates the principles and values by which our company operates. As a delegate and/or FDR for CareSource, your organization and downstream entities must abide by your own policies and procedures, standards of conduct, and compliance plan. These policies and procedures similar in scope and content to the compliance policies and procedures and code of conduct held by CareSource. You may also have the option to use CareSource’s compliance policies and procedures to meet these requirements.
PRESIDENT & CEO | Erhardt Preitauer
In the Company’s history, many important achievements have supported our member experience. None of that would have been possible without a foundation of honesty and ethical behavior.
The Corporate Compliance Plan should be used as a compass for every employee when faced with the difficult decisions you encounter in your work. I am proud knowing that you make the right decision on behalf of CareSource for every member.
There is nothing more important than our reputation, and it is upheld every day based on the actions of every employee. I challenge you to think about your decisions and actions, and make sure they are held in the highest integrity to support our vision and mission.
Thank you for your dedication and commitment to the CareSource vision, your honesty and integrity, and your unwavering commitment to our CareSource members.
- “There is nothing more important than our reputation, and it is upheld every day based on the actions of every employee.”
On behalf of the Risk Committee of the Board and all Board and Committee members, we would like to thank you for your hard work and dedication to the CareSource mission. We are comforted in the fact that you have been trained in the elements of compliance and ethical behavior. We challenge each of you to strive for the highest ethical and compliance standards. Know that you have the support and confidence of the entire Risk Committee and all Board and Committee members to execute the Company’s vision and mission.
As you review the Compliance Plan, identify one area of your work where you can apply these concepts each day. That will keep the culture of compliance at CareSource strong and vibrant and ensure the utmost integrity in all we do.
CORPORATE COMPLIANCE OFFICER
The role of the Corporate Compliance Officer for the CareSource family of companies is to ensure CareSource has an effective compliance program. That does not mean that only the Corporate Compliance Officer is responsible for compliance. In fact, each of us is responsible for compliance. Our motto is “Chart your Course with Compliance”. We hope you see Corporate Compliance and all integrated assurance functions as resources to improve ourselves and the work we do to support CareSource’s vision and mission.
Health care is complicated, with many different Regulators and regulations. It is impossible to memorize every regulation for every situation. However, there are several fundamental elements that are important to understand to stay on the right path to compliance. The concepts of compliance are simple, but the Company’s transactions and situations can be complicated and unique to each of your roles.
As you read this document, please think about your work at CareSource and use this guide to help anticipate where compliance risks exist. The single most important thing you can do is keep your eyes and ears open for areas of improvement. We firmly believe our best opportunity to identify gaps and improvement areas is for the 3,000 plus employees of CareSource to identify and escalate compliance concerns. The first stop is your Manager. They are expected to have an open door policy for compliance and ethics matters. We expect them to engage you by asking where you have concerns. Please help us make sure that happens.
If your manager does not address your concern, you can contact the Ethics Hotline anytime day or night. The contact information is on the back of your employee badge. Please do not hesitate to contact us; reports are confidential and addressed timely. We trust that if we work together, we will be great.
After reviewing the compliance plan, we expect you to understand the key elements and keep them visible in your day-to-day work. If you are faced with a compliance or ethics question, we hope you will keep the Compliance Compass in mind.
Remember, your actions or inactions determine whether CareSource is a compliant company.
You are encouraged to contact us directly to discuss compliance, or if you have suspicions of noncompliance, by emailing CareSourceComplianceOfficer@caresource.com.
Interoperability Patient Access, Provider Directory and Payer to Payer Data Exchange
If you would like to inquire about access to CareSource Patient Access, Provider Directory, or Payer to Payer Data Exchange APIs as part of the Interoperability and Patient Access final rule (CMS-9115-F) from the Centers for Medicare & Medicaid Services, please send an email with your contact information to email@example.com.
CareSource Patient Access, Provider Directory, and Payer-to-Payer APIs
If you are interested in more technical information about the CareSource Patient Access and Provider Directory APIs – please use the following links:
- Patient Access API CRT Environment Swagger Information
- Patient Access API Production Environment Swagger Information
- Provider Directory API CRT Environment Swagger Information
- Provider Directory API Production Environment Swagger Information
- Payer to Payer API Swagger Information
CareSource Employee Medical Plan Machine Readable Files
UnitedHealthcare creates and publishes the Machine-Readable Files on behalf of the CareSource Management Services LLC Employee Medical PlansTo link to the Machine-Readable Files, please click on the URL provided: https://transparency-in-coverage.uhc.com/