Notice Date: December 4, 2025To: Ohio MyCare LTSS and HCBS ProvidersFrom: CareSource Subject: Next Generation MyCare Ohio Waiver Providers Training and Office Hours Effective Date: December 4, 2025 SummaryCareSource is pleased to announce upcoming Provider Training sessions and Office Hours for NextGeneration MyCare Ohio Waiver Providers. These events are designed to help providers learn about CareSource processes, ask questions, and connect with our team. Sessions will be offered virtually (via Teams) . Impact Providers will have access to detailed training sessions to understand CareSource requirements and processes. Training will be offered on Mondays and Wednesdays throughout December. Office hours will be offered on Tuesdays and Thursdays throughout December. Weekend and evening hours are available to support providers prior to go-live on January 1, 2026. Office Hours offer real-time support and an opportunity to submit questions in advance. Participation in these sessions will help providers stay informed, streamline onboarding, and ensure access to support resources and success as new provider in Next Generation MyCare Ohio.Registration for office hoursRegistration for training Questions?For questions or support, contact:CareSourceOHLTSS HCBSSupport@caresource.com Y0119_OH-DSNP-P-4845926_C
Notice Date: December 4, 2025 To: TRICARE Prime Demo Providers From: CareSource Military & Veterans Subject: Georgia Provider Orientation Effective Date: December 18, 2025 Summary In anticipation of the TRICARE Prime Demo by CareSource Military & Veterans (CSMV) product launch, the Provider Engagement Team will be offering a variety of convenient orientation options designed to better meet providers needs, including live sessions across the state. Our Provider Orientation focuses on the collaborative processes that support us working together, and we ask providers to prioritize completing orientation prior to January 1, 2026.Registering for the Orientation Registration is easy! Providers can go to HealthPlanResources.com and use their NPI* and the password ProvidersR#1 to log in. They can then select the live session of their choice, watch a recording of a live session (after December 15, 2025) or take our on-demand version of orientation training. Providers can also request a one-on-one orientation session. *If the learner does not have an NPI number, the learner will set up a new account using a unique email address as their username. To use single sign-on in the future, they will use the same email address and password when accessing the Provider Portal.Impact HealthPlanResources.com consolidates all provider orientation, education resources and opportunities in a single location. Live training schedules and registration are available in the learning management system (LMS) as well as access to our on-demand education library. Importance Orientation allows providers to gain key insights into operational details and requirements in advance of the go-live date of January 1, 2026. Practice managers may track, complete and attest to training/orientation completion on behalf of their group, ensuring that annual training requirements are successfully met. Prior to Go-Live | In Person & Virtual SessionsLocation Date and Time Additional InformationVirtual Register Online at HealthPlanResources.com Thursday, December 18 9 a.m. Eastern Time (ET) Virtual session Register Online at HealthPlanResources.com Thursday, December 18 12:30 p.m. ET Virtual session Register Online at HealthPlanResources.com Thursday, December 18 4 p.m. ET Virtual session
2025 CareSource Prior Authorization List Prior authorization (PA) is how we decide if the health services listed below will be covered by a members CareSource plan. Providers must get PA before any services. The services must be evidence-based and medically necessary for a members care. Services must also fall within the terms of the members health plan. Emergency care does not need PA. If a provider is not part of the CareSource network, the member or provider must get PAbefore any service , not just those listed below. Care may not be covered without PA. Services That Require PA All Medical Inpatient Care including Acute, Skilled Nursing Facility, Inpatient Rehabilitation/Therapy, Long Term and Respite care, Hospice Out-of-Network services (excluding emergency services) Elective surgeries (outpatient and inpatient) Reconstructive and/or potential cosmetic services, including but not limited to: o Rhinoplasty o Most limb deformities o Cleft lip and palate Oral surgery ( that is dental in origin ) for adults Bariatric/gastric obesity surgery Knee/hip replacements, some knee orthoses Arthroscopies/arthroplasties Laminectomies/laminotomies Spinal fusions Laparoscopies UPPP surgery (Uvulopalatopharyngoplasty) Coronary artery bypass graft (CABG) Genetic testing in some situations Hyperbaric Oxygen Therapy Sleep studies outside of home setting Voluntary sterilizations Gender dysphoria services, including but not limited to gender transition surgeries Treatments and services associated to temporomandibular or craniomandibular joint disorder and craniomandibular jaw disorder Maternity: o Delivery and inpatient stay if scheduled less than 39 weeks , or if stay exceeds 48 hours for vaginal or 96 hours for cesarean delivery Non-emergent ambulance services Urine Drug Testing (UDT) Behavioral Health Services: All inpatient services Applied Behavior Analysis (ABA) Partial Hospitalization Program (PHP) servicesCareSource.com Psychiatric Diagnostic Evaluation (PA after three units/visits per calendar year) Intensive Outpatient Program/Treatment (IOP/IOT) services Individual Psychotherapy ( PA after 24 units/visits per calendar year) Family Psychotherapy ( PA after 24 units/visits per calendar year) Psychiatric Residential Treatment Facility (PRTF) services Assertive Community Treatment (ACT) Community Support services Electroconvulsive Therapy (ECT) Intensive Customized Care (IC3 ) Medical Supplies and Appliances The following always require a PA: All custom equipment All miscellaneous codes ( Example: E1399) Cochlear implants including most replacements. PA also consider s the post cochlear implant aural therapy. Cranial Remolding Helmets Donor milk Left Ventricular Assist Device (LVAD) Oral nutrition (for medical purposes) and enteral nutritional therapy Wheelchairs and some associated accessories Insulin infusion device Continuous Glucose Monitors All rental/lease items, including but not limited to: o CPAP/BiPAP o NPPV machines o Apnea Monitors o Ventilators o Hospital beds o Specialty mattresses o High frequency chest wall oscillators o Cough assist/stimulating device o Pneumatic compression devices o Speech generating devices and accessories o Infusion pumps Wound Vacs Durable Medical Equipment (DME) and supplies, including but not limited to: o Prosthetic and orthotic devices**o Oral appliances for obstructive sleep apnea o Patient transfer systems/ Hoyer lifts o Power wheelchair repairs o Spinal cord stimulators **Orthotics can be replaced once per benefit year when medically necessary. Additional replacements may be allowed if damaged and unable to repair , or if need is driven by rapid growth and member is under 18 years of age. Excludes repair/replacement due to lost and stolen, misuse, malicious breakage or gross neglect.CareSource.com HomeCare Services and Therapies No PA required for any therapy/skilled nurse/social worker/infusion therapy assessment Home Health aide visits Private duty nursing (PDN) Skilled nurse visits Social worker visits Occupational Therapy Speech Therapy Physical Therapy Outpatient Therapies Prior authorization requirements include Habilitative, Rehabilitative, or a combination of both. No prior authorization required for any therapy/skilled nurse/social worker/infusion therapy assessment Occupational Therapy visits Speech Therapy visits Physical Therapy visits Cardiac Rehabilitation Therapy Cognitive Rehabilitation Therapy Pulmonary Rehabilitation Therapy Physical Medicine and Rehabilitation Services (including day rehabilitation and acute inpatient rehabilitation facility stays ) Transplants, including but not limited to: Heart Islet cell transplant Kidney transplant Liver transplant Lung or double lung transplant Multiviceral transplant Pancreas transplant Simultaneous pancreas/kidney Small bowel transplant Stem cell/bone marrow transplant (with or without myeloablative therapy) Transportation and lodging costs Bone marrow/stem cell donor search fees Pain Management Epidural steroid injections Trigger point injections Implantable pain pump Implantable spinal cord stimulator Most sacroiliac joint procedures Sacroiliac joint fusion Most facet joint interventionsCareSource.com Additional Important Information:Providers are responsible for verifying eligibility and benefits before providing services. Authorization is not a guarantee of payment for services. GA-MED-P -3746937 DCH Approved: 12/3/2025
WebinarTranscriptOpen [VISUAL] Fade in from black. Lower third: TRICARE Prime Demo by CareSource Military & VeteransSuper: Atlanta, GA & Tampa,FL Introductions LAUREN Welcome.Todaywere talking about the TRICARE Prime Demonstration by CareSource Military & Veterans.Im Lauren Hope, a military spouse of nineteen years and a military advocate. Like many of you, Ive navigated health care during deployments, PCS moves, and what we call normal family life-which in the military,can be anything but normal. Our goal today is simple: to give you clear answers about your health care options in plain language. Im joined by Selene Martin, Associate VicePresident of Corporate Affairsat CareSource Military & Veterans,a veteran military spouse, and she comes from a history of military service in her family too. Selene, thank you for being here. SELENE Thanks, Lauren. Itsgood to be here. We know health care is complex and not always understood. Todaywell keep it straightforward, so families in Atlanta and Tampa can learn about their options and know where to go for help. LAUREN Exactly .This isnt a sales pitch-its information to help you make the best choice for your family.W ell walk through what the TRICARE Prime Demo is, what it might mean for you, and then take questions from community influencers and advocates who gathered input from their followers. [ON-SCREEN CALL-TO-ACTIONFOOTER] Questions? Call Beneficiary Services 833-230-2080 | VisitCareSourceMilitary.comCare YouDeserve, A Choice YouveEarnedLAUREN Selene, this line really stands out-Care you deserve, a choice youve earned. Why does this matter now for families in Atlanta and Tampa?SELENE Military families carry a lot. For beneficiaries in these two markets, the TRICARE Prime Demo means you now have a choice in who manages your TRICARE Prime coverage. YourTRICARE benefits dont change. Whats new is being able to select who helps manage your care experience. Choice helps families find support that fits their needs. LAUREN That sa big shift. For years, most of us havent had a say in who we work with-we just took what was assigned. Having a real choice means you can find a team that understands both health care and military life.SELENE Exactly .Itsabout recognizing that every familys needs are differentand giving them the space to choose support that fits. [ON-SCREEN TEXT] Benefits stay TRICARE Prime New-Choice of plans Markets-Atlanta & TampaWhen Care Feels Like Understanding LAUREN In my own experience, weve had PCMs-primary-care managers-who really get military life, and some who dont. What does care and understanding look like here? SELENE Understanding means meeting families where they are, respecting military life, and removing friction from the process. With the demo, CareSource Military & Veteransbrings teams who know this community. Wehelp you through things like referrals, appointments, mental health, and all the in-betweens that can add stress. LAUREN That makes such a difference.Sometimes what families need most isnt another brochure-itssomeone who listens and explains things in plain English. SELENE Exactly .Wewant health care to feel like a partnership. [ON-SCREEN TEXT] Plain-language, caring support Help with the in-betweens Mental health & caregiver tools (All acronyms defined in the glossary of the downloadable resource packet.) Who WeServe LAUREN Let stalk about who this actually applies to, because thats one of the biggest questions families ask: Does this include us? SELENE The TRICARE Prime Demo option is open to: Active duty family members National Guard or Reserve family members, if their sponsor is activated Retirees, retiree family members, and survivors who arent eligible for Medicare Beneficiaries enrolled in the TransitionalCompensation Program Gold star family membersLAUREN That s a wide group. And just to confirm-if someone isnt in Atlanta or Tampa,or doesnt meet the demo criteria, will anything change with their current TRICARE coverage? SELENE That s correct. If you are not in Atlanta or Tampa,or do not meet the eligibility criteria for the demonstration, your current TRICARE coverage wont change. The only difference for eligible families in these two locations is that they now have the option to choose who manages their care. LAUREN So, if youre in Atlanta or Tampaand you qualify,you now get a say in who you work with. If not, you keep what you have. SELENE Exactly .And if youre unsure, call 833-230-2080 or visit CareSourceMilitary.com and use the Check Eligibility tool. [ON-SCREEN TEXT] Check Eligibility CareSourceMilitary.com| Call 833-230-2080 The TRICARE Prime Demo [VISUAL] Diagram: TRICARE Prime Benefits = Same Plan = YourChoice. LAUREN Okay ,lets unpack this title-TRICARE Prime Demo. What does it actually mean? SELENE It ssimple. YourTRICARE Prime benefits stay the same. Whatsnew is that, if you live in Atlanta or Tampa,you can choose which participating plan delivers those benefits. LAUREN So same coverage, same benefits-just the option to pick who supports your care. SELENE Exactly .Think of it like a favorite recipe: the ingredients stay the same, but now you can choose which trusted chef prepares it. LAUREN (laughs) Thats a perfect analogy.We just want it to run smoothly-no surprises. SELENE And thatsour goal: to make the process clear and supportive from start to finish. [ON-SCREEN CTAFOOTER] Questions? Call 833-230-2080 | VisitCareSourceMilitary.comWhat Makes Us DifferentLAUREN Selene, I know youre humble, but what sets CareSource apart for families in this demo? SELENE Weve served families with complex needs for more than 35 years. Wefocus on people first.That means no network referrals to slow you down, 24/7 nurse support, integrated mental health, and customer service by people who understand military life. LAUREN And because youre nonprofit, that means your resources go back into care, not shareholders. SELENE Exactly .Wereinvest to improve quality and expand community programs that strengthen families. LAUREN That s something families will feel-fewer hoops, more help. [ON-SCREEN TEXT] No network referrals 24/7 Nurse Support Integrated Mental Health Mission-Driven Partner Health Care That Stands With YouLAUREN This isnt just about coverage; its about care that actually stands with you. What does that look like? SELENE It looks like wraparound support. Along with TRICARE Prime benefits, we connect families to mental health resources, caregiver tools, and peer navigation. When you call, youre not just asking about claims-youre connecting to someone who can help you manage life events that impact your health. LAUREN I can relate. When my husband deployed, the hardest parts werent medical-it was everything else piling up. SELENE Exactly .Were there for those in-between moments too-finding specialists, answering follow-ups, or connecting you to community support. [ON-SCREEN TEXT] WraparoundSupport Mental Health Resources Caregiver & Peer Navigation Grounded in the Places YouCall Home SELENE Wereinvesting locally-not just showing up. In both Atlanta and Tampa,we partner with veteran mental health nonprofits, spouse-employment programs, and peer-support groups. LAUREN So youre not replacing whatsthere-youre adding strength to whats already working. SELENE Exactly .Trust is earned by listening and showing up consistently.LAUREN Families remember who stands beside them when things get tough.SELENE That s what it means to be grounded in the communities we serve. [ON-SCREEN TEXT] Local partnerships Veteran& Spouse Programs Peer Support Networks A Mission-Driven Partner LAUREN Selene, youve lived this life as a military spouse and now lead in this space. Why does this mission matter to you? SELENE CareSource has decades of experience serving families with complex needs, including nearly ten years in Georgia. But for me, its personal. Ive seen how hard it can be to find care that feels human. At CareSource Military & Veterans,were changing that-one family ,one phone call at a time. LAUREN Youcan feel the heart behind it. Families need leaders who both understand and act. SELENE It s a privilege to serve those who serve. Frequently Asked Questions Segment LAUREN If I already have a doctor I love, do I have to switch because of this demo? SELENE Youcan keep your doctor if they accept TRICARE Prime through CSMV.Call Beneficiary Services if you need help confirming. LAUREN Does this change my TRICARE benefits? SELENE No. Yourbenefits stay the same. What changes is who supports your care in Atlanta and Tampa.LAUREN Same benefits, more choice-simple and clear.W e also heard this one a lot-What happens if I PCS? SELENE A PCS is a qualifying life event. If you move outside Atlanta or Tampa,youll pick from the TRICARE health plan options available in your new area. LAUREN So your coverage moves with you. What about my prescriptions? SELENE Your pharmacy benefits stay the same. LAUREN Another big question-How do I decide between health plans? SELENE Think about what matters most to you: referral rules, mental-health access, local partnerships, or tools like nurse lines and Navigators. Compare those features to find your best fit. LAUREN When can I choose? SELENE During TRICARE Open Season-November 10 through December 9, 2025-or after a qualifying life event. LAUREN Mark those dates; they sneak up fast every year.Closing LAUREN Selene, thank you for walking us through the TRICARE Prime Demo. And to everyone watching-you dont have to figure this out alone. If you have questions, call Beneficiary Services at 833-230-2080 or visit CareSourceMilitary.com.Y ou can also connect with us at events across Atlanta and Tampa.SELENE And remember TRICARE Open Season runs November 10 through December 9, 2025. That s your opportunity to review your options and make the choice that fits your family best. LAUREN On behalf of the entire CareSource Military & Veteransteam-thank you for spending time with us today,and for everything you do for our country and communities. SELENE It san honor to serve those who serve. [ON-SCREEN CTAFOOTER] Questions? Call 833-230-2080 | VisitCareSourceMilitary.com| Open Season Nov 10-Dec 9 2025 [ON-SCREEN DISCLAIMER] The Defense Health Agency does not endorse any single contractor.CSMV-TRICARE-C-4418325DHA Approve: 11/20/2025
NonDiscrimination Notice | Language Assistance We follow all state and federal civil rights laws. We do not discriminate, exclude, or treat people differently based on race, color, national origin, disability, age, religion, sex (which includes pregnancy, gender, gender identity, sexual preference, and sexual orientation), or based on marital, health, or public assistance status. We want all people to have a fair and just chance to be as healthy as they can be. : H R I I H U I U H H D L G V V H U Y L F H V D Q G U H D V R Q D E O H P R G L F D W L R Q V L I R X K D Y H D G L V D E L O L W : H F D Q J H W a sign language interpreter. This helps you talk with us or to your providers. Get your printed materials in large print, audio, or braille at no cost. We can also help if you speak a language other than English. We can get an interpreter who speaks your language. Or get printed materials in your language. You can get this all at no cost to you.