Provider Portal Quick Reference Guide: Managing User AccessSet up your TRICARE Prime Demo by CareSource Military & Veterans Provider Portal account by following the instructions in the Provider Portal Solutions Quick Reference Guide found on the or viewing Provider Education Series:
Claims Payment System ic Errors (CPSE) Update Report Confidential and Proprietary As of: December 16, 2025Listed below are current CPSE. This log is updated monthly. Please review this log for CPSE updates on status, target dates for reprocessing and resolutions. If you have questions after reviewing the log, please call Provider Services at 1-8 00-488-0134. Unique ID and Description of CPSE Line of Business Date CPSE was First Identified Billing Provider Type(s) Impacted by CPSE (select all that apply) Timeline for Fixing CPSE Date(s) and/or Date Span(s) of Corrected Claims Adjustments CPSE Status Unique ID CSO0605736:Confirmed CPSEColonoscopy codes (see below) paid without applying member responsibility. This is a potential overpayment to claims. Codes Include:00811, 45380,45381.45382,45384,45385,45380,99153,G0500 MyCare 8/13/2025 20-Physician/Osteopath, Individual 24-Physician Assistant68-Anesthesia Assistant, Individual72-Nurse Practitioner, Individual73-Certified Registered Nurse Anesthetist (CRNA), Individual80-Independent Laboratory 10/2/202510/16/202510/23/2025 Target claims reprocessing date 11/20/2025 to 11/27/2025Target claims reprocessing date 12/12/2025 to 12/19/2025 In Process Unique ID CSO0615319:Confirmed CPSEAnesthesiology code 00797 (Anesthesia for intraperitoneal procedures in upper abdomen including laparoscopy; gastric restrictive procedure for morbid obesity) paid at 35% of billed charges and should pay aligning with the OAC rule which states base unit value + time unit value x conversion factor x multiplier. This is a potential overpayment to claims. Medicaid 9/5/2025 20-Physician/Osteopath, Individual 10/9/2025 10/16/2025 Target claims reprocessing date 11/13/2025-11/20/2025Target claims reprocessing date 12/22/2025-12/29/2025 In Process Unique ID CSOH001:Confirmed CPSESkygen dental claims denied 1096 (Service Authorization not Found) and should pay without authorization for In Network providers. After additional analysis of the impact reports, this was reclassified as a Confirmed CPSE. This is a potential underpayment to claims. MyCare 7/25/2025 30-Dentist, Individual 9/26/2025 Target claims reprocessing date 11/14/2025-11/21/2025 Target claims reprocessing date 12/31/2025-1/7/2026 In Process Unique ID DYNTC0001156:Confirmed CPSEMyCare Opt In Speech Therapy codes (see below) paid without an authorization and should deny. This is a potential overpayment to claims.Codes Include:92507, 92526, 97129, 97150, 97750 MyCare 10/6/2025 40-Speech Language Pathologist, Individual 10/30/2025 Target claims reprocessing date 12/1/2025-12/8/2025 Target claims reprocessing date 12/22/2025-12/29/2025 In Process Unique ID CSO0642179:Confirmed CPSENot CPSERadiology codes paid using the Centers for Medicare and Medicaid (CMS) multiple surgery reduction and radiology codes with multiple procedure indicator 4 should pay according to the CMS radiology multiple surgery reduction using the PFS Relative Value Files. This is a potential underpayment/overpayment to claims. Medicaid & MyCare 10/6/2025 20-Physician/Osteopath, Individual24-Physician Assistant27-Chiropractor, Individual36-Podiatrist, Individual 72-Nurse Practitioner, Individual76-Durable Medical Equipment Supplier 10/27/2025 Target claims reprocessing date 11/24/2025-12/1/2025 Remove from log Unique ID CSO0624710:Confirmed CPSEWaiver claims paid at billed charges without applying patient liability. This is a potential overpayment to claims. MyCare 10/14/2025 45-Waivered Services Organization 55-Waivered Services, Individual 11/3/2025 Target claims reprocessing date 12/1/2025-12/8/2025 Claims reprocessed on 11/24/2025 Completed Unique ID CSO0642291:Confirmed CPSEMyCare Opt In pharmacogenomics-gene testing for behavioral health indication codes (see below) denied X94 (Service Requires and authorization) and should pay. This is a potential underpayment to claims. Codes Included:0029U,0030U,0031U,0032U,0033U,0034U,0070U,0071U,0072U,0073U,0074U,0075U,0076U,0117U,0175U,0193U,0286U,0345U,0347U,0348U,0350U,0392U,0411U,81220,81225,81226,81230,81231,81232,81247,81283,81291,81306,81328,81335,81346,81350,81355,81401,81406,81407,81408,81418,81479 MyCare 10/22/2025 80-Independent Laboratory 12/4/2025 12/3/2025 Target claims reprocessing date 1/1/2026-1/8/2026Target claims reprocessing date 12/31/2025-1/7/2026 In Process Unique ID CSO0647500:Confirmed CPSEDurable Medical Equipment Code B9998 (Not Otherwise Classified for enteral supplies) denied 3E1 (Service requires authorization) when billed with U1 (4 units per month) and U2(1 unit per day) modifiers and should pay for Par Providers. This is a potential underpayment to claims. Medicaid & MyCare 10/22/2025 76-Durable Medical Equipment Supplier 11/12/2025 11/17/2025 Target claims reprocessing date 11/10/2025-11/17/2025Target claims reprocessing date 12/15/2025-12/22/2025 In Process Unique ID CSO0631758:Confirmed CPSEBehavioral Health Service codes (see below) denied 7LR (Primary carrier final decision required.) and should pay. This is a potential underpayment to claims. Codes Included:H0004,H0005,H0006,H0011,H0015,H0020,H0036,H0038,H0048,H2000,H2012,H2017,H2019,H2020,H2036,86702,90460,90633,90785,90791,90832,90834,90837,90839,90847,90853,J0571,J0574,S5000,T1502 Medicaid & MyCare 10/24/2025 20-Physician/Osteopath, Individual 37-Licensed Independent Social Worker (LISW)38-Private Duty Non-Agency RN or LPN47-Professional Clinical Counselor72-Nurse Practitioner, Individual 11/13/2025 Target claims reprocessing date 12/11/2025-12/18/2025 In Process Unique ID CSO0641044:Confirmed CPSEEffective 4/1/2025, laboratory and pathology codes (see below) billed in place of service 11 denied X05 (invalid place of service for procedure) and should pay. This is a potential underpayment to claims. Codes Included:80076,87493,87632,87633 Medicaid & MyCare 10/28/2025 20-Physician/Osteopath, Individual 24-Physician Assistant72-Nurse Practitioner, Individual76-Durable Medical Equipment Supplier 11/17/2025 Target claims reprocessing date 12/15/2025-12/22/2025 In Process Unique ID CSO0644351:Confirmed CPSEBehavioral Health procedure code H2019 (Therapeutic behavioral services, per 15 minutes) billed with the HQ modifier with place of service other than place of service codes 11 and 53 paid and should deny. This is a potential overpayment to claims. Medicaid & MyCare 10/28/2025 37-Licensed Independent Social Worker (LISW) 47-Professional Clinical Counselor 10/31/2025 Target Claims reprocessing date 12/12/2025-12/19/2025 In Process Unique ID CSO0635136:Confirmed CPSENot CPSEInpatient Facility claims with an admit date of the year 2023 denied S23 (Date req. Prior to Subscriber effective date.) and should pay. This is a potential underpayment to claims. Medicaid & MyCare 10/30/2025 01-Hospital (Inpatient)02-Psychiatric Hospital03-Psychiatric Residential Treatment Facility (PRTF)44-Hospice86-Nursing Facility 11/17/2025 Target Claims reprocessing date 12/8/2025-12/30/2025 Remove From Log Unique ID CSO0643995:Confirmed CPSEOutpatient Hospital claims denied CBI (COB information not received) and should pay. This is a potential underpayment to claims. Medicaid 11/17/2025 01-Hospital (Outpatient) 46-Ambulatory Surgery Center59-End-Stage Renal Disease (Dialysis) Clinic80-Independent Laboratory 12/4/2025 Target Claims reprocessing date 1/1/2026-1/8/2026 In Process Unique ID CSO0656917:Confirmed CPSELaboratory Codes (see below) denied X99 (Not a covered service/procedure) and should pay when billed with the blood testing diagnostic code Z02.83. This is a potential underpayment to claims.Codes Included:G0480, G0481, G0482, G0483 Medicaid & MyCare 12/1/2025 01-Hospital (Outpatient) 80-Independent Laboratory 12/31/2025 Targeted Claims reprocessing date 1/28/2026-2/4/2026 In Process Confidential and Proprietary Unique ID and Description of CPSE Line of Business Date CPSE was First Identified Billing Provider Type(s) Impacted by CPSE (select all that apply) Timeline for Fixing CPSE Date(s) and/or Date Span(s) of Corrected Claims Adjustments CPSE Status Unique ID Dental120125:Confirmed CPSEDentaQuest Dental claims billed with bitewing X-Rays denied 2105 (Service allowance included as part of another benefit.) when a paid panoramic X-Ray is on file and should pay. After additional analysis of the impact reports, this was reclassified as a Confirmed CPSE. This is a potential underpayment to claims. Medicaid 12/1/2025 12-Federally Qualified Health Center 30-Dentist, Individual31-Professional Dental Group 11/4/2025 Claims reprocessed on 11/20/2025 Completed Unique ID CSO0667092:Confirmed CPSEHospital claims billed with the procedure code 75580 (Noninvasive estimate of coronary fractional flow reserve (FFR) derived from augmentative software analysis of the data set from a coronary computed tomography angiography, with interpretation and report by a physician or other qualified health care professional) denied X94 (Service Requires Authorization) and should pay. This is a potential underpayment to claims. Medicaid & MyCare 12/3/2025 01-Hospital (IP & OP) 12/31/2025 Targeted Claims reprocessing date 1/28/2026-2/4/2026 In Process Unique ID CSO0651092:Confirmed CPSERehabilitation therapy codes (see below) billed with place of service 12,13 or 14, are incurring a cost share and should not. This is a potential underpayment to claims.Codes Included:97012, 97035, 97110, 97112, 97530 MyCare 12/9/2025 16 & 60-Home Health Agency 39-Physical Therapist, Individual40-Speech Language Pathologist, Individual41-Occupational Therapist, Individual74-Assisted Living Facilities 1/5/2026 Target Claims reprocessing date 2/2/2026-2/9/2026 In Process Unique ID DYNTC0001156:Confirmed CPSEOutpatient claims billed with behavioral health procedure code H0040 (Assertive community treatment program, per diem) denied X94 (Service Requires Authorization) and should pay for Par providers. This is a potential underpayment to claims. MyCare 12/9/2025 37-Licensed Independent Social Worker (LISW) 51-Mental Health Clinic54-Licensed Independent Chemical Dependency Counselor72-Nurse Practitioner, Individual84-Ohio Department of Mental Health (Community Mental Health) Provider 12/22/2025 Targeted Claims reprocessing date 2/2/2026-2/9/2026 In Process Unique ID CSO0645877: Confirmed CPSEBehavioral Health claims denied 4VX (Disallow Verify render phy./Dup service) when a claim has a different provider, same taxID, same date of service, same place of service and different billed charges and should pay. This is a potential underpayment to claims. Medicaid & MyCare 12/10/2025 20-Physician/Osteopath, Individual 37-Licensed Independent Social Worker (LISW)47-Professional Clinical Counselor54-Licensed Independent Chemical Dependency Counselor72-Nurse Practitioner, Individual84-Ohio Department of Mental Health (Community Mental Health) Provider 12/18/2025 Targeted Reprocessing date 1/27/2026-2/3/2026 In Process Confidential and Proprietary
Notice Date: December 11, 2025 To: Indiana Medicaid Providers From: CareSource Subject: Third Party Liability (TPL) Summary To ensure that state Medicaid programs, such as Hoosier Healthwise (HHW) and Healthy Indiana Plan (HIP), do not reimburse expenses covered by other sources, federal regulation (Code of Federal Regulations 42 CFR 433.139) establishes Medicaid as the payer of last resort. Impact When a provider determines that a member has an available TPL resource, the provider is required to bill that resource prior to billing CareSource. Providers may access information about CareSource members other insurance resources through the CareSource Provider Portal. Importance If CareSource indicates that a member has TPL, and the provider submits the claim to CareSource without documentation that the third-party resource was billed, federal regulations (with a few exceptions, as described in the Indiana Health Coverage Programs [ IHCP] TPL Provider Reference Modules ) require that the claim be denied. To resolve a claim denial due to TPL, please submit a corrected claim, including the primary insurance explanation of payment, to CareSource within the timely filing guidelines. Questions? Providers may contact Provider Services at 1-844-607-2831 for further information regarding TPL and how to register or how to navigate the CareSource Provider Portal. Provider Services is available Monday through Friday, 8 a.m. to 8 p.m. Eastern Time (ET)/7 a.m. to 7 p.m. Central Time (CT). IN-MED-P-4676227; First Use: 12/11/2025 OMPP Approved: 12/11/2025
Notice Date: December 12, 2025 To: Indiana Medicaid Providers From: CareSource Subject: MDwise Transition Pharmacy Network Update Effective Date: January 1, 2026 Summary Effective Jan . 1, 2026, MD wise will no longer be a managed care plan option for Healthy Indiana Plan (HIP) or Hoosier Healthwise (HHW) members. Members will have to select a new managed care plan or go through the auto-assignment process. CareSource is here to serve your HIP and HHW pat ients. Impact We want to inform providers and pharmacies of the largest retail p harmacy network variations between CareSource and MD wise. Walgreens and Kroger retail pharmacies are currently not in the CareSource Pharmacy network. If your MD wise patient is switching to CareSource and currently utilizing Walgreens , Kroger, or any other out-of-network pharmacy, w e encourage you to work on a plan to switch prescriptions to an in-network retail pharmacy or proactively send new prescriptions to an in-network pharmacy for use on or after January 1st. In-network pharmacy locations can be found by using the Find a Pharmacy tool . Pharmacies that are in CareSources Indiana Medicaid retail network, particularly those in proximity to Walgreens or Kroger, should anticipate an increase in prescription volume as a result. Please note: MD wise members will maintain their MD wise coverage through December 31st.Prescriptions filled on Dec . 3 1, 2025 or prior will still default to MDw ises pharmacy network. Importance Ensuring your patient s transitioning to CareSource have prescriptions sent to a pharmacy in CareSources network for use on or after Jan. 1, 2026 will help to ensure continuity of care. Questions? We are here to help with any questions. Please reach out to CareSource Provider Services at 1-844-607-2831. We are open Monday through Friday, 8 a.m. to 8 p.m. ET. IN-MED-P -4848550 OMPP Approved: 12/10/25
NV-Multi-P-4744788 2025 CareSource. All Rights Reserved.PROVIDER PORTAL SOLUTIONSTime-Saving Benefits of the Provider Portal: Member Eligibility & Termination Multiple member eligibility look-up for up to 24 months and member termination, if applicableClaims Information Check claim status, submit claims and necessary attachments, submit and check status of claim disputes and appeals Coordination of Benefits Confirm coordination of benefits for patients Payment History Search for payments by check number or claim number Explanation of Payment Access from the secure portal with the option to print Prior Authorization Medical inpatient/outpatient, specialty pharmacy and prior authorization warning messages to verify accuracy Care Treatment Plans Easily provide input into your patients care plans and consult with Care Managers Care Management Referrals Automated care management forms for efficient enrollment Member Profile Comprehensive view of patient medical/pharmacy utilizationClinical Practice Registry Innovative online tool showing health partners when members are in need of tests or services; filter data to show preventive health opportunities Resources Access training modules that help navigate portal functionalities Tools You Need to Save You TimeAt CareSource, we make it easier for you to do business with us 24 hours a day, seven days a week with our free, secure Provider Portal. Easy to AccessOur Provider Portal is free, secure and easy to use. Visit CareSource.com and click Login > Provider at the top right corner. Select your state portal. Enter your username and password and click Login. Four easy steps to register for the portal: Click Sign Up to establish your account by creating your username and password. For added security, set up the multi-factor authentication.To connect your account, you will need your Provider Name, Tax ID, Provider ID and your ZIP Code.Review and accept the Agreement. 1234
Aviso de prcticas de privacidad de HIPPA EN ESTE AVISO, SE DESCRIBE CMO SE PUEDE USAR YDIVULGAR LA INFORMACIN MDICA SOBRE USTED YCMO PUEDE OBTENER ACCESO A ESTA INFORMACIN. REVSELO DETENIDAMENTE. En este aviso, tambin nos referiremos a nosotros como CareSource. Sus derechos En lo que se refiere a su informacin mdica, tiene ciertos derechos: Obtener una copia de sus registros mdicos y de reclamos Puede solicitar ver u obtener una copia de sus registros mdicos y de reclamos. Tam bin puede obtener otra informacin mdica suya que tengamos. Pregntenos cmo hacerlo. Le entregaremos una copia o un resumen de sus expedientes mdicos y de reclamos. C on frecuencia lo hacemos en un plazo de 30 das. Solicitar que corrijamos sus expedientes mdicos y de reclamos Puede solicitarnos que corrijamos sus expedientes mdicos y de reclamos si considera que s on errneos o estn incompletos. Pregntenos cmo hacerlo. Podemos rechazar su solicitud. Si lo hacemos, le diremos el motivo por escrito en un pl azo de 60 das. Solicitar comunicaciones privadas Puede pedirnos que nos comuniquemos con usted de una forma especfica, por ej emplo, a travs de un nmero de telfono particular o del trabajo. Puede pedirnos que cambiemos la direccin a la que enviamos su correspondencia. Analizaremos todas las solicitudes razonables. Debemos aceptar su solicitud si nos i ndica que usted podra estar en peligro en caso de no hacerlo. Solicitar que limitemos lo que usamos o compartimos Puede pedirnos que no usemos ni compartamos determinada informacin mdica para l a atencin, los pagos o nuestras operaciones. No estamos obligados a aceptar esta solicitud. Podemos rechazar su solicitud si esto c ambiase su atencin o por otros motivos. Obtener una lista de aquellos con los que hemos compartido la informacin Puede pedirnos una lista (rendicin de cuentas) de las veces que hemos compartido su i nformacin mdica. Esta lista solo mostrar los seis aos anteriores a la fecha que solicita. Puede preguntar con quin hemos compartido su informacin y por qu. Incluiremos todas las divulgaciones, salvo aquellas relacionadas con lo siguiente: o la atencin; o los pagos; o operaciones de atencin mdica; y al gunas otras divulgaciones (por ejemplo, alguna que nos haya solicitado hacer). Obtener una copia de este aviso de privacidad Puede solicitar una copia impresa de este aviso en cualquier momento. Puede hacerlo incluso s i acord recibir el aviso en formato electrnico. Le entregaremos una copia impresa a la mayor brevedad posible. Otorgar a CareSource consentimiento para hablar con alguien en su nombre Puede darnos su consentimiento para hablar sobre su informacin mdica con otra persona en su nombre. Si tiene un tutor legal, esa persona puede hacer elecciones sobre su informacin m dica. Le daremos su informacin mdica a su tutor legal. Nos aseguraremos de que el tutor legal tenga este derecho y pueda actuar en su nombre. Nos encargaremos de esto antes de realizar alguna accin. Presentar una reclamacin si siente que se vulneran sus derechos Puede contactarnos para presentar una reclamacin si siente que violamos sus derechos. Use la informacin al final de este aviso. Puede presentar una reclamacin ante la Oficina de Derechos Civiles del Departamento de Salud y Servicios Humanos de Estados Unidos de tres maneras:o Por correo postal a 200 Independence Ave., S.W., Washington, D.C. 20201 o Por telfono al 1-877-696-6775. o En www.hhs.gov/ocr/privacy/hipaa/complaints/ . No tomaremos ninguna accin en su contra por presentar una reclamacin. No podem os exigirle que no haga uso de su derecho de presentar una queja como condicin para lo siguiente:o la atencin, o el pago,o la inscripcin en un plan de salud, o o la elegibilidad para los beneficios.Sus opciones Para determinada informacin mdica, puede indicarnos sus preferencias con respecto a lo que compartimos. Indquenos qu desea que hagamos. Haremos lo que nos diga. En estos casos, tiene el derecho y la opcin de indicarnos que hagamos lo siguiente:Otros usos y divulgaciones Cmo usamos o compartimos, por lo general, su informacin mdica? Generalmente, usamos o compartimos su informacin mdica de estas formas. Se han sealado algunos ejemplos. No hemos incluido una lista de todos los usos o divulgaciones admisibles. Para ayudarle a recibir tratamiento mdico. Podemos usar su informacin mdica y compartirla con los especialistas que lo estn t ratando. o Ejemplo: Podemos coordinar atencin adicional para usted segn la i nformacin que nos enve su mdico. Para administrar nuestra organizacin Podemos usar y compartir su informacin para manejar nuestra compaa. La usamos para comunicarnos con usted cuando sea necesario. No podemos usar informacin gentica para decidir si le daremos cobertura. No podem os usarla para decidir el precio de la cobertura. o Ejemplo: Podemos usar su informacin para revisar y mejorar la calidad de la at encin mdica que usted y otros reciben. Podemos brindar su informacin mdica a organizaciones externas para que nos puedan ayudar en nuestras operaciones. Esos grupos externos pueden s er: abogados contadores consultores y otros Nosotros tambin les exigimos que mantengan la confidencialidad de su informacin mdica. Para pagar por su atencin mdica Usaremos y divulgaremos su informacin mdica al pagar por su atencin mdica. o Ejemplo: Compartimos informacin sobre usted con su plan dental para coordinar el pago de sus trabajos dentales. De qu otra forma podemos usar o compartir su informacin mdica? Tenemos permitido o se nos exige compartir su informacin de otras formas. Dichas formas a m enudo son para contribuir con el bien pblico, como la salud pblica o una investigacin. Debemos cumplir con muchas condiciones de la ley antes de poder compartir su informacin por estos motivos. Para obtener ms informacin, consulte: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html Para ofrecer ayuda con problemas de seguridad y salud pblica Podemos compartir informacin mdica acerca de usted en algunos casos, como por ejemplo para:informacin sobre la atencin mdica reproductiva. Ya no est protegida por la ley o por las protecciones y restricciones vigentes cuando est en nuestro poder. Nuestras responsabilidades Protegemos su informacin mdica de muchas formas. Esto incluye la informacin es crita, verbal o disponible en lnea. o Nuestro personal est capacitado para proteger sus datos. o Se habla sobre su informacin de manera que no se escuche por casualidad. o Nos aseguramos de que las computadoras usadas por los empleados sean s eguras mediante el uso de cortafuegos y contraseas. o Limitamos quin puede ver sus datos de salud. Nos aseguramos de que solo el per sonal que tenga un motivo comercial para acceder a la informacin pueda verla, usarla y compartirla. La ley nos exige que mantengamos la privacidad y la seguridad de su informacin m dica protegida. Debemos entregarle una copia de este aviso. Si hubo una violacin que pueda comprometer la privacidad o la seguridad de sus dat os, se lo haremos saber de inmediato. Debemos cumplir con las obligaciones y prcticas de privacidad descritas en este aviso. D ebemos entregarle una copia. No usaremos ni compartiremos sus datos de manera distinta a la que aqu se menciona, a m enos que nos autorice por escrito. Si usted nos autoriza, puede cambiar de opinin en cualquier momento. Hganos saber por escrito si cambia de parecer. Para obtener ms informacin, visite: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html . Fecha de entrada en vigencia y cambios en los trminos de este avisoEste aviso original entr en vigor el 14 de abril de 2003. Se actualiz el 14 de junio de 2018. E sta versin se encuentra en vigor desde el 1 de enero de 2026. Debemos cumplir con los trminos de este aviso durante todo el tiempo que est en vigencia. Si fuese necesario, podemos modificar el aviso. El nuevo aviso se aplicara a toda la informacin mdica que conservamos. Si esto sucede, le enviaremos un nuevo aviso si lo solicita. Tambin se publicar en nuestro sitio web. Puede solicitar una copia impresa de este aviso en cualquier momento. Comunquese con el Funcionario de Privacidad de CareSource para solicitarla. Puede comunicarse con el Funcionario de Privacidad de CareSource de las siguientes maneras: Correo postal: CareSource Attn: Privacy Officer P.O. Box 8738 Dayton, OH 45401-8738 Correo electrnico: HIPAAPrivacyTeam@CareSource.com Telfono: 1-844-633-0391 (TTY: 711) GA-MED-M-3208539a-SPA Aprobado por DC H: 12/8/2025
HIPAA Notice of Privacy Practices THIS NOTICE DESCRIBES HOW MEDICAL INFORMATION ABOUT YOU MAY BE USED AND DISCLOSED AND HOW YOU CAN OBTAIN ACCESS TO THIS INFORMATION. PLEASE REVIEW IT CAREFULLY. We will call ourselves CareSource, we or us in this Notice. Your Rights When it comes to your health information, you have certain rights: Get a copy of your health and claims records You can ask to see or get a copy of your health and claims records. You can also get ot her health information we have about you. Ask us how to do this. We will give you a copy or an outline of your health and claims records. We often do this w ithin 30 days. Ask us to fix health and claims records You can ask us to fix your health and claims recordsif you think they are wrong or dont have all the details. Ask us how to do this. We may say no to this ask . If we do, we will tell you why in writing within 60 days. Ask fo r private communications You can ask us to reach out to you in a certain way, such as home or office phone. You c an ask us to change the address we send your mail to. We will think about all fair requests. We must say yes if you tell us you would be in dangerif we do not. Ask us to limit what we use or share You can ask us not to use or share certain health information for care, payment, or our oper ations. We do not have to agree to this ask. We may say no if it would change your care or for c ertain other reasons. Get a list of those with whom weve shared information You can ask for a list (accounting) of the times weve shared your health information. This list will only show six year s before the date you ask. You may ask who we shared it with, and why.We will include all the disclosures except for those about: oCare, o Payment(s) , o Health care operations, and Certain other disclosures (such as any you asked us to make). Get a copy of this privacy notice You can ask for a paper copy of this notice at any time. You can ask even if you have agreed to getthe notice electronically. We will give you a paper copy soon after . Give CareSource consent to speak to someone on your behalf You can give us consent to talk about your health data with someone else on your behal f. If you have a legal guardian, that person can make choices about your health information. We will give health data to your legal guardian. We will make sure a legal guardian has this right and can act for you . We will do this before we take any action. File a complaint if you feel your rights are violated You can complain if you feel we have violated your rights by contacting us . Use the i nformation at the end of this notice. You can file a complaint with the U.S. Department of Health and Human Services Office for Civil Rights in three ways:o Send a letter to 200 Independence Av e., S.W., Washington, D.C. 20201 o Call 1-877-696-6775 o Visit www.hhs.gov/ocr/privacy/hipaa/complaints/ . We will not act against you for filing a complaint. We may not require you to give up your r ight to file a complaint as a condition of: o care, o payment, o enrollment in a health plan or o eligibility for benefits. Your Choices For certain health information, you can tell us your choices about what we share. Tell us what you want us to do. We will do as you say . In these cases, you have both the right and choice to tell us to: Share data with your family, close friends or others involved in payment for your care Share data in a disaster relief situation We can use your health information and share it with experts who are treating you o Example: We may arrange more care for you based on information sent to us by y our doctor. Run our organization We can use and give out your information to run our company. We use it to contact you when needed. We cannot use genetic information to decide whether we will give you coverage. We c annot use it to decide the price of that coverage. o Example: We may use your information to review and improve the quality of health care you and others get . We may give your health information to outside groups so they can help us with our business. Such outside groups may be: Lawyers, Accountants, Consultants And others. We require them to keep your health information private, too. Pay for your health care We can use and give out your health information as we pay for your health care. oExample: We share information about you with your dental plan to arrange pay ment for your dental work. How else can we use or share your health information? We can or must share your information in other ways. These ways are often to help the public good,such as public health and research. We must meet many conditions in the law before we can share your information for these reasons. To learn more see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/index.html To help with public health and safety issues We can share health information about you in some cases, such as to: o Prevent disease o Help with product recalls o Report harmful reactions to drugs o Report suspected abuse, neglect or domestic violence o Prevent or reduc e a serious threat to anyones health or safety To do research We can use or share your information for health research. We can do this as long as c ertain privacy rules are met. We will let you know quickly if a breach may have compromised the privacy or security of your data. We must follow the duties and privacy practices in this notice. We must give you a copy of it. We will not use or share your data other than as listed here unless you tell us we can in w riting. If you tell us we can, you may change your mind at any time. Let us know in writing if you change your mind. To learn more see: www.hhs.gov/ocr/privacy/hipaa/understanding/consumers/noticepp.html . Effective date and changes to the terms of this noticeThe original notice was effective April 14, 2003 . It was further updated on June 14, 2018. This v ersion is effective as of January 1, 2026. We must follow the terms of this notice as long as it is in effect. If needed, we can change the notice. The new one would apply to all health information we keep. If this happens we will send you a new notice if you ask for it . It will also be posted on our web site. You can ask for a paper copy of our notice at any time . Reach out to the CareSource Privacy Office to ask for it . The CareSource Privacy Office can be reached by: Mail: CareSource Attn: Privacy Office P.O. Box 8738 Dayton, OH 45401-8738 Email: HIPAAPrivacyTeam@CareSource.com Phone: 1-844-633-0391 (TTY: 711) GA-MED-M-3208539a DCHApproved: 11/20/2025
Provider Portal Submission User Guide 1 CareSource Military & Veterans Provider Portal Claim Submission User Guide Table of Contents Page 1. Introduction ………………………………………………………………………………………………………………………………. 3 2. Prerequisites ……………………………………………………………………………………………………………………………. 3 3. Landing Page …………………………………………………………………………………………………………………………… 3 4. Menu Items ………………………………………………………………………………………………………………………………. 4 4.1. Dashboard …………………………………………………………………………………………………………………………… 5 4.2. Create Claim ………………………………………………………………………………………………………………………… 8 4.3. Actions ………………………………………………………………………………………………………………………………. 17 4.4. Reports ……………………………………………………………………………………………………………………………… 18 Provider Portal Submission User Guide 2 Table of Images Image 1: Search Claims ………………………………………………………………………………………………………………….. 3Image 2: Filter options available in Select Filter ………………………………………………………………………………….. 3Image 3: Landing Screen …………………………………………………………………………………………………………………4Image 4: Menu Tab ………………………………………………………………………………………………………………………… 5Image 5: Processed by date dashboard …………………………………………………………………………………………….. 5Image 6:Claim Submission Distribution …………………………………………………………………………………………….. 5 Image 7:New HCFA Form ………………………………………………………………………………………………………………. 7 Image 8:Pop-up for Save ………………………………………………………………………………………………………………… 8Im age 9 : Validation Message …………………………………………………………………………………………………………… 9 Image 10: Pop-up for Submit ……………………………………………………………………………………………………………. 9 Image 11: Pop-u p for Submit ………………………………………………………………………………………………………….. 10 Image 12:New UB Form ……………………………………………………………………………………………………………….. 10 Image 13: Pop-u p for Save …………………………………………………………………………………………………………….. 11 Image 14: Validation message ……………………………………………………………………………………………………….. 11Image 15: Pop-up for Submit ………………………………………………………………………………………………………….. 12 Image 16: Pop-u p for Submit ………………………………………………………………………………………………………….. 12 Image 17: Attachment Tab …………………………………………………………………………………………………………….. 13Image 18: Attachment Tab …………………………………………………………………………………………………………….. 14Image 19: Search Claims ………………………………………………………………………………………………………………. 14Image 20: Search Claims ………………………………………………………………………………………………………………. 14Image 21: Upload Claims ………………………………………………………………………………………………………………. 15Image 22: Upload Claims ………………………………………………………………………………………………………………. 16Image 23: Actions…………………………………………………………………………………………………………………………. 17Image 24: Actions…………………………………………………………………………………………………………………………. 17Image 25: Copy Claim-HCFA ……………………………………………………………………………………………………….. 17 Image 26: Copy Claim-UB ……………………………………………………………………………………………………………. 18 Image 27: Reports ………………………………………………………………………………………………………………………… 18Image 28: Audit Trail …………………………………………………………………………………………………………………….. 19Provider Portal Submission User Guide 3 1.IntroductionThe Claims Direct Data Entry (DDE) Portal allows user to perform direct data entry of Health Care Financing Administration (H CFA) and Uniform Billing (U B) claims, along with the attachment of appropriate supporting documentation. The user can also upload claim s and their associated attachments . 2.Prerequisites1. Operating System: Windows 7 & Abov e 2.Bro wser: Google Chrome, Edge3. Landing PageThe Landing Page appears as shown below . 1. The document status screen appears as shown below .2. You can filter according to search criteria listed under the Select filter s . This enables you to search according to defined criteria, such as claim ID, document number, insur ed i nformation, patient information, total charges or status . You can also search with no filters select ed and thi s will return all claims submitted by the user with the recent submissions at top.3. Click on thebutton to execute the search. 4. Click on the Select filters button to s earch with any additional search condition. 5. Click on the button to refresh the filter screen. Image 1: Search Claims Im age 2: Filters Option Available in Select Filters Provider Portal Submission User Guide 4 4. Menu Items When you click on the Home button, you will land upon a below landing screen Image 3: Landing Screen Click on the Menu Tab and the following list will appear:Provider Portal Submission User Guide 5 Image 4: Menu Tab 4.1. Dashboard The Dashboard menu items allow you to CREATE HCFA or CREATE UB claims. It also provides the opportunity to attach and upload supporting documentation using DDE mode. 1. New Claim Shortcut Links: a. Create HCFA Open the DDE screen for Professional/HCFA claims b. Create UB Open the DDE screen for Institutional/UB claims 2. Reports Shortcut Link Open the Reports page 3. Processed By Day Represents the count of documents processed, by date 4. Claim Submission Distribution Displays the percentage distribution of the different types of documents processed 5. Provider Submission Count Shows the number of documents submitted by the provider Image 5: Processed by Day Dashboard Image 6: Claim Submission DistributionProvider Portal Submission User Guide 6 4.2. Create Claim1. Click CREATE New HCFA Claim a. The HC FA form appears as shown below: Provider Portal Submission User Guide 7 Image 7: New HCFA Form If you are submitting a void or replacement claim transaction, please complete box 22. For replacement or corrected claim submission, enter resubmission code 7 in the left box labeled Code and enter the original claim number of the claim you are replacing in the right box labeled Original Ref No. If submitting a void or cancel claim request, enter resubmission code 8 in the left box labeled Code and enter the original claim number of the claim you are voiding in the right box labeled Original Ref No .Provider Portal Submission User Guide 8 For atypical providers who are required to use their Medicaid ID instead of an NPI, enter G2 in B. I.D . Qualifier box and the Medicaid ID in the B. ID box of section 33 (Billing Provider I.D Qualifier and ID). Once the Medicaid ID is entered, delete the NPI value that was populated in box A.NPI. b.Complete the form with all the relevant information. c. A claim can be saved to review and update later by clicking on the Save button . The claim ID will be generated, which can be copied to search in future. To copy a claim, click on Copy Claim ID . To close the pop-up and to continue working on the claim, click on the Close button.Image 8: Pop-up for SaveProvider Portal Submission User Guide 9 d. Some fields are mandatory and must be entered. A validation message will appear when mandatory field(s) are left blank. Image 9: Validation Message e. Once the claim data is filled, the claim can be submitted using the Submit button Once the button is clicked, a confirmation pop-up will appear asking if the claim needs to be submitted, user can select Submit if the claim wants to be submitted or select Cancel to close the pop-up and to continue working on the claim . Image 10: Pop-up for SubmitProvider Portal Submission User Guide 10 Once Submit is chosen, you will have three options : a. Copy Claim ID to copy the claim ID generated. b. Create New HCFA Claim to start entering a new claim . c. Back to Search Page to get back to the Search Page.Image 11: Pop-up for Submit2. Click CREATE New UB04 Claim a. The UB form appears as shown below: Image 12: New UB Form b. Complete the form with all the relevant information. c. A claim can be saved and worked upon later by clicking on the Save button . The claim ID will be generated which can be copied to search in future. To copy claim, click onProvider Portal Submission User Guide 11 Copy Claim ID . To close the pop-up and to continue working on the claim, click on Close button. Image 13: Pop-up for Save d. Some fields are mandatory and must be entered. A validation message will appear when mandatory field(s) are left blank. Image 14: Validation Message Provider Portal Submission User Guide 12 e. Once the claim data is filled, the claim can be submitted using the Submit button . Once the button is clicked, a confirmation pop-up will appear asking if the claim needs to be submitted. Select Submit to move forward with the submission, or select Cancel to close the pop-up and continue working on the claim . Image 15: Pop-up for SubmitOnce Submit is chosen, you have three options : a. Copy Claim ID to copy the claim ID generated. b. Create New UB04 Claim to start entering a new claim . c. Back to Search Page to get back to the Search Page.Image 16: Pop-up for SubmitAttachments Tab in DDE a. If supporting documentation/attachments need to be submitted with the claim, click on the Attachments tab. The upload screen appears as shown below: b. A similar view like the one below will be shown for UB claim form s.Provider Portal Submission User Guide 13 Image 17: Attachment Tab c. Click anywhere on the grey area above to and choose the file for attachment. 1. If multiple attachments are required, repeat this step to add additional attachments as needed. 2. The total file size of all attachments should not exceed 100 MB. Multiple attachments can be chosen to upload. You can choose one of the options below from the drop-down to mention the type of attachment being added. d. You can view the uploaded image by clicking on the file name.Provider Portal Submission User Guide 14 Image 18: Attachment Tab e. Click on the Form tab to return to the claim. f. You can submit the claim from the Form tab or Attachments tab by using the Submit option. After submi ssion is completed, you will be returned to the Dashboard page. Status of Claim Once the claim is submitted, the claim can be searched with the claim ID provided. The status of the claim will be Submit_Finished, which means the document is submitted in the Provider Portal.Image 19: Search ClaimsAfter the claim is submitted in portal and downstream system, the status will change to External_E xport_Finished. At this point DCN will be generated, which can be used for further communications . Claim IDs can also be used for further communications or to search. Image 20 : Search ClaimsProvider Portal Submission User Guide 15 Other status available are as follows : 837 Submission in Progress Interim status which shows that the DDE/Upload claim is converted to EDI and 837 is submitted. 837 Successfully Submitted 837 is submitted to adjudication system . 837 Submitted and Waiting for Acknowledgement 837 submitted to front end system and waiting for adjudication. In Progress Claim entered in screen but not submitted in portal yet. Submit Started Once submit is initiated by the user after DDE/Upload. Submit Finished Once submit is successful . Submit Error If claim is submitted by user but error was encountered during submit. Resubmitted If a claim is resubmitted by user . Rejected Claim is rejected by CS adjudication . External Export Finished When claim is exported from portal to create EDI. UPLOAD: Upload is used to upload any attachment. The c laim and its attachment should be uploaded; mu ltiple attachments are allowed to be uploaded.Image 21: Upload claimsClick anywhere on the grey box or drag and drop the file from any file folder to upload an attachment. 1. If multiple attachments are required, repeat this step to add additional attachments as needed. 2. The total file size of all attachments should not exceed 50 MB. Provider Portal Submission User Guide 16 Multiple attachments can be chosen to upload. The user can choose one of the below from dropdown to mention the type of attachment being added. Image 22 : Upload Claim Provider Portal Submission User Guide 17 4.3. Actions You can perform the action below for claims that were previously entered in direct data entry mode. 1. Options below are available on an IN_PROGRESS claim (i.e., a claim which is not yet submitted) Image 23 : Actions a. Edit is used to edit the saved claim. A claim cant be edited after submitted. b. View is used to view the claim . c. Copy is used to copy a claim . 2. Options below are available on a submitted claim.Image 24: Actions a. In addition to options a, b, c mentioned above, you can select Resubmit to correct the previously submitted claim . Copy Claim : The user can copy a claim . In this case, you will have two options : Full copy Partial copy Full copy is used when the entire content of the claim has to be copied. This copies the whole claim, excluding attachments . Partial copy is used when particular subsections of the claim have to be copied. On HCFA partial copy , the options shown below will copy the respective box on selection. Image 25: Copy Claim-HCFA Provider Portal Submission User Guide 18 On UB partial copy, the options shown below will copy the respective box on selection. Image 26: Copy Claim-UB4.4. Reports 1. The status of documents previously submitted via the portal can be viewed by accessing the Reports > Document Status Reports menu item. a. This allows for different search options to locate the status of a claim that has been uploaded via the portal. i. The document status screen appears as shown below: Image 27: ReportsProvider Portal Submission User Guide 19 ii.Fi lter using the search criteria listed under the Report s f ilter. This enables the ability to searc h ac cording to defined criteria, such as document number, insured information, patien t i nformation, state, total charges or status .iii. Click on the button to ex ecute the search. Click on the Xbutton to clear the selection. Audit Tr ail: a. Audit Trail Action performed for the respective document can be tracked systematically . I mage 28: Audit Trail CSMV-TRICARE-P- 4807048
Notice Date: December 9, 2025 To: Arkansas PASSE Providers From: CareSource PASSE Subject: Change to Vision Services Effective Date: January 1, 2026 Summary We are notifying you of an upcoming change to vision services for CareSource PASSE members. Effective January 1, 2026, routine vision benefits (such as eye exams and glasses) will be carved out of the PASSE program. These services will be provided through the Arkansas Medicaid Fee-for-Service (FFS) program. CareSource PASSE members will access routine vision care from FFS providers rather than through PASSE networks. What Stays the Same? Ophthalmology services (medical eye care) will remain in the PASSE. Examples of ophthalmology services include diagnosing and treating conditions such as glaucoma and cataracts and performing procedures such as cataract sur gery. Care coordination responsibilities do not change. CareSource PASSE Care Coordinators will continue to assist members with all vision services, both routine and medical, to ensure continuity of care. Impact to PASSE Organizations PASSEs will no longer be financially responsible for routine vision services after January 1, 2026. PASSEs must continue to coordinate care for all vision services, including helping members find FFS providers for routine vision care. Questions? Please contact Provider Services at 1-833-230-2100, available Monday through Friday from 8 a.m. to 5 p.m. Central Time (CT) . AR-PAS-P- 4829657
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