Check Eligibility
We recommend that you check member eligibility each time a member presents for services, as member eligibility can fluctuate. Changes in health status such as pregnancy or certain medical conditions may also cause changes in plan eligibility.
| Important Tools | |
| Provider Portal | Member ID Card |
You can easily verify member eligibility by accessing the Provider Portal or through an eligible Electronic Data Interchange (EDI) clearinghouse. | The member ID card is used to identify a member; it does not guarantee eligibility or benefits coverage. Members may disenroll from CareSource PASSE™ and retain their previous ID card. Members may lose Medicaid eligibility at any time. |
You can always verify member eligibility by accessing the Provider Portal or through an eligible Electronic Data Interchange (EDI) clearinghouse.
Quick Tips: Member Consent
When you check eligibility on the Provider Portal, you can also determine if a member has granted consent to share sensitive health information (SHI).
When a member has a sensitive health diagnosis (e.g., treatment for drug/alcohol use, genetic testing, HIV/AIDS, mental health or sexually transmitted diseases), you should verify if the patient has granted consent to share health information. On the Provider Portal, a message displays on the Member Eligibility page if the member has not consented to sharing sensitive health information.
Please encourage CareSource PASSE members who have not consented to complete a HIPAA Authorization Form so that all providers involved in their care can effectively coordinate their care.
The HIPAA Authorization Form can also be used to designate a person to speak on the member’s behalf. This designated representative can be a relative, a friend, a physician, an attorney or some other person that the member specifies.
Want more information?
For questions not addressed on our website, please call Provider Services at 1-833-230-2100. You can reach us Monday through Friday from 8 a.m. to 5 p.m. Central Time (CT).