We realize that you perform administrative tasks in addition to tasks directly related to patient care.
To assist you with these tasks, we’ve consolidated the information below.
Providers may not bill members for any covered services.
To charge the member for non-covered services, the provider must obtain written acknowledgement that the member is assuming financial responsibility prior to the service being rendered. The member’s written acknowledgement must come with a clear description of the services the member would be responsible for paying and not include any conditional language.
Providers may not charge members for services which CareSource PASSE™ denied based on lack of medical necessity or lack of compliance to contractual terms. Providers may not bill members for missed appointments. A member may not be billed for medically necessary emergency services.
Regulations state that providers must hold members harmless in the event that CareSource PASSE does not pay for a covered service performed by the provider unless CareSource PASSE denies prior authorization of the service and the provider notifies the member in writing that the member is financially responsible. This must be done prior to providing the service, and the member must sign and date the notification.
If the CareSource PASSE member requests a service not covered by Medicaid, the provider may charge the member for the service as long as the member has been told prior to receiving the service that it was not covered and the member has provided signed acknowledgment they were notified prior to the service.
If the provider does not tell the member that the service is not covered until after it has been rendered, the provider cannot bill the member.
Member Rights & Responsibilities
As a CareSource PASSE provider, you are required to respect the rights of our members. CareSource PASSE members are informed of their rights and responsibilities via their member handbook. Please review our member rights and responsibilities and ensure your practice is in compliance.