These policies are regularly reviewed, updated, withdrawn or added; and therefore, subject to change.
Please check often for updates to provider policies.
Policies may vary by plan and/or state. Click the links to access policies for your member’s plan.
The policies presented on these pages may not be inclusive of all applicable provider policies. Some benefit management services are provided on behalf of CareSource. Please reference applicable policies from our delegated service providers.
The policies below are in PDF format. If you do not have Adobe Acrobat Reader, you may download it here.
Medical policies provide guidelines for determining medical necessity and appropriate care for approved benefits.
Pharmacy policies provide guidelines for specialty drugs.
Reimbursement policies provide guidance for claim payments.
Administrative policies offer guidance for determining medical necessity, investigational and experimental services.