Re: Summary of Formulary Changes Effective July 1, 2026 Dear CareSource Marketplace Member, Your Formulary is an important part of your Prescription Drug Benefit . It shows what drugs m ay be covered for you, what limits may apply, and what tier drugs are in. A committee of health care providers, like doctors and pharmacists , decide what will be included on your Formulary. This is called the Pharmacy and Therapeutics (P&T) Committee. The P&T Committee looks at your Formulary regularly to make sure it is up-to-date. The P&T Committee met recently to update the Formulary. Please review the tables to see how the Formulary is changing. Drugs in this table will be added to the Formulary effective July 1, 2026. DRUG NAME FORMULARY TIER COVERAGE LIMITS Accu-Check (Roche) test strips 2 QL Estradiol 0.01% Vaginal Cream 1 QL Freestyle (Abbott) test strips 2 QL Tadalafil 20 mg tablets (generic for Adcirca) 4 PA PA = Prior Authorization QL = Quantity Limits ST = Step Therapy Drugs in this table will be removed from the Formulary effective July 1, 2026. DRUG NAME NOTES Adcirca (tadalafil) Removed from formulary. OneTouch (LIFESCAN) Test Strips and Meter Removed from formulary. Drugs in this table have had a change in how they are covered. This could include a c hange in their Formulary tier and/or adding or removing a coverage limit. Detailsare below. DRUG NAME COVERAGE CHANGE Adalimumab (Humira, Abrilada, Amjevita, Cyltezo, Hadlima, Hulio, Hyrimoz, Idacio, Yuflyma, Yusimry) Reauthorization criteria updated. Multi-EXC-M-4945150-V.3 CareSource.com/MarketplaceEculizumab (Soliris, Bkemv, Epysqli) Reauthorization criteria updated. Omnipod, V-Go, Cequr Criteria Updated. Tryngolza (olezarsen) Policy updated. Ustekinumab (Stelara, Imuldosa, Otulfi, Pyzchiva, Selarsdi, Starjemza, Steqeyma, Wezlana, Yesintek) Reauthorization criteria updated. Please talk to your provider or pharmacist about these change s. They can help you get a new prescription if needed. A new prescription may or may not be the best choice for you. If not, you or your provider can request an exception. You can find the Member Exception Request for Non-Formulary Medication form on CareSource.com . Your provider can also submit a request el ectronically or by faxing it to 866-930-0019. If you or your provider have questions, please contact Member Services at the number on your ID card. Sincerely, CareSource Marketplace You and your provider can find the full Formulary and other information on the Drug Formulary page on CareSource.com . Multi-EXC-M-4945150-V.3 CareSource.com/Marketplace
Page 1 of 3 Re: Summary of Formulary Changes Effective July 1, 2026 Dear Health Partner , We are dedicated to partnering with you to manage our members care in the most effective way. The CareSource Pharmacy and Therapeutics (P&T) Committee meets regularly to review the Marketplace Drug Formulary and make updates as necessary. The P&T Committee met recently to update the Formulary. Please review the tables below to see how the Formulary is changing. Additional information about viewing the full Formulary and drug-specific criteria and policies is found at the end of this notice. Drugs in this table will be added to the Formulary effective July 1, 2026:DRUG NAME FORMULARY TIER COVERAGE LIMITSAccu-Check (Roche) test strips 2 QL Estradiol 0.01% Vaginal Cream 1 QL Freestyle (Abbott) test strips 2 QL Tadalafil 20 mg tablets (generic for Adcirca) 4 PA PA = Prior Authorization QL = Quantity Limits ST = Step Therapy Drugs in this table have had a change in how they are covered. This could include a change in their Formulary tier and/or adding or removing a coverage limit. Details are below.DRUG NAME COVERAGE CHANGEAdalimumab (Humira, Abrilada, Amjevita, Cyltezo, Hadlima, Hulio, Hyrimoz, Idacio, Yuflyma, Yusimry) Reauthorization criteria updated. Eculizumab (Soliris, Bkemv, Epysqli) Reauthorization criteria updated. Omnipod, V-Go, Cequr Criteria Updated. Tryngolza (olezarsen) Policy updated. Ustekinumab (Stelara, Imuldosa, Otulfi, Pyzchiva, Selarsdi, Starjemza, Steqeyma, Wezlana, Yesintek) Reauthorization criteria updated. NV-EXC-P-5281800 Page 2 of 3 Drugs in this table were reviewed by the P&T Committee and will have no changes totheir Formulary status. Additional clinical updates are noted.DRUG NAME NOTES Accrufer (ferric maltol) Age Expansion. Aflibercept (Eylea, Eylea HD, Pavblu) New Indication. Bevacizumab (Alymsys, Avastin, Mvasi, Zirabev, Avzivi, Jobevne) Annual review.Blujepa (gepotidacin) New indication review.Camzyos (mavacamten) Annual review. Cysteamine bitartrate (Procysbi and Cystagon) Annual review.Cysteamine hydrochloride solution (Cystaran and Cystadrops) Annual review.Cytogam (human cytomegalovirus immune globulin liquid) Annual review.Daybue (trofinetide) New dosage form review. Dojolvi (triheptanoin) Annual review.Evrysdi (risdiplam) New dosage form review. Farxiga (dapagliflozin) Annual review. Filspari (sparsentan) Annual review. Itvisma (onasemnogene abeparvovec-brve) New drug review medical benefit. Jardiance (empagliflozin) Annual review. Long-Acting Opioids Quality improvement review. Itvisma (onasemnogene abeparvovec-brve) New drug review medical benefit. Myqorzo (aficamten) New drug review. Nocdurna (desmopressin acetate) Annual review. Nulibry (fosdenopterin) Annual review. Orladeyo (berotralstat) Age expansion review. Pegasys (peginterferon alfa-2a) Annual review. Reblozyl (luspatercept-aamt) Annual review. Redemplo (plozasiran) New drug review. Rituximab (Rituxan, Truxima, Ruxience, Riabni) Annual review. NV-EXC-P-5281800 Page 3 of 3DRUG NAME NOTESShort-Acting Opioids Quality improvement review. Spinraza (nusinersen) Annual review. Sucraid (sacrosidase) Annual review. Tarpeyo (budesonide) Annual review. Tonmya (cyclobenzaprine) New drug review. Uplizna (inebilizumab-cdon) New indication review medical benefit. Wegovy (semaglutide oral) New dosage form review. Zolgensma (onasemnogene abeparvovec-xioi) Annual review. Zycubo (copper histidinate) New drug review. We can provide a list of CareSource members taking any medication upon request. Please email your request to PharmacyConversionProgram@CareSource.com . Include medication names and your secure fax number in your request. We will fax you a list of your patients who were prescribed these medications. We know patient care is of the utmost importance to you. We sent a letter to members who may be negatively impacted due to these changes. In our letter, we recommended members contact their prescriber if they have questions. Additional Resources You can view the full CareSource Marketplace Drug Formulary on the Provider pages at CareSource.com . Select Drug Formulary from the Tools & Resources menu under the Providers drop down. The Drug Formulary page also includes a link to our online Formulary Search Tool. We recognize each patient is unique, and we appreciate your partnership in transitioning members who may be impacted by the Formulary changes above. We are here to help you with any questions. Call Provider Services at 1-833-230-2101. We are open Monday through Friday, 8 a.m. to 5 p.m. Eastern Time (ET). Thank you for being a CareSource health partner. Sincerely, CareSource Marketplace
NV-EXC-M -5281801 CareSource.com/Marketplace Re: Summary of Formulary Changes Effective July 1, 2026 Dear CareSource Marketplace Member, Your Formulary is an important part of your Prescription Drug Benefit . It shows what drugs may be covered for you, what limits may apply, and what tier drugs are in. A committee of health care providers, like doctors and pharmacists , decide what will be included on your Formulary. This is called the Pharmacy and Therapeutics (P&T) Committee. The P&T Committee looks at your Formulary regularly to make sure it is up-to-date. The P&T Committee met recently to update the Formulary. Please review the tables to see how the Formulary is changing. Drugs in this table will be added to the Formulary effective July 1, 2026 .DRUG NAME FORMULARY TIER COVERAGE LIMITS Accu-Check (Roche) test strips 2 QL Estradiol 0.01% Vaginal Cream 1 QL Freestyle (Abbott) test strips 2 QL Tadalafil 20 mg tablets (generic for Adcirca) 4 PA PA = Prior Authorization QL = Quantity Limits ST = Step Therapy Drugs in this table have had a change in how they are covered. This could include a change in their Formulary tier and/or adding or removing a coverage limit. Details are below.DRUG NAME COVERAGE CHANGEAdalimumab (Humira, Abrilada, Amjevita, Cyltezo, Hadlima, Hulio, Hyrimoz, Idacio, Yuflyma, Yusimry) Reauthorization criteria updated.Eculizumab (Soliris, Bkemv, Epysqli) Reauthorization criteria updated.Omnipod, V-Go, Cequr Criteria Updated. Tryngolza (olezarsen) Policy updated.Ustekinumab (Stelara, Imuldosa, Otulfi, Pyzchiva, Selarsdi, Starjemza, Steqeyma, Wezlana, Yesintek) Reauthorization criteria updated.NV-EXC-M -5281801 CareSource.com/Marketplace Please talk to your provider or pharmacist about these changes. They can help you get a new prescription if needed. A new prescription may or may not be the best choice for you. If not, you or your provider can request an exception. You can find the Member Exception Request for Non-Formulary Medication form on CareSource.com . Your provider can also submit a request electronically or by faxing it to 866-930-0019. If you or your provider have questions, please contact Member Services at the number on your ID card. Sincerely, CareSource Marketplace You and your provider can find the full Formulary and other information on the Drug Formulary page on CareSource.com.
Notice Date: April 15, 2026 To: TRICARE Prime Demo Providers From: CareSource Military & Veterans Subject: Referral Waiver Extended Through June 30, 2026 Summary TRICARE Prime Demo by CareSource Military & Veterans (CSMV) has extended the referral waiver period. It is now in effect through June 30, 2026 . Please review the guidance below when scheduling TRICARE Prime Demo beneficiaries. In-network specialists: No referral required. Out-of-network (OON) specialists: Beneficiaries may choose OON care; encourage coordination through their assigned in-network Primary Care Manager (PCM). After June 30, 2026, a PCM referral is required to avoid point-of-service costs. Impact Action for providers: Verify eligibility and network participation prior to the visit when possible, using the CSMV Provider Portal . If OON, confirm whether a PCM referral/authorization will be on file (as applicable) for dates of service after June 30, 2026, or contact Provider Services at 1-833-230-2170 for assistance. Questions? Contact Provider Services at 1-833-230-2170 . We are available Monday through Friday from 8 a.m. to 6 p.m. Eastern Time (ET). CSMV-TRICARE-P -5404832
SPRING 2026 PROVIDER Source A Newsletter for Medicaid and MI Coordinated Health IN THIS ISSUE: 2 Chief Medical Ofcer's Note 3 Network Notication Bulletin 3 Find Updates from HAP CareSource Online 3 Exciting News: Launch of Our New Learning Management System! 3Pharmacy Updates for Medicaid 4The KED Measure: Kidney Health Evaluation for Patients with Diabetes 4How Do Your Patients Perceive You? 5Hepatitis Cand Sickle Cell Disease: Removing Barriers for Patients 5Importance of Proper Documentation 5Health Needs/Risk Assessment (HRA/HNA) Available Through CareSource MyLife 6In-Lieu of Service (ILOS) Food Service 6Identifying Behavioral Health Concerns: A Key to Better Patient Outcomes 7HAP CareSource would like to remind you about our website HAPCareSource.comChief Medical Ofcers NoteThe material in this newsletter applies to HAP CareSource and HAP CareSource MI Coordinated Health (HMO D-SNP). When stating HAP CareSource, the content applies to all plans Medicaid, MI Coordinated Health unless otherwise noted. HAP CareSource's mission has always been built on the foundation of partnershipwith the physicians, advanced practitioners and care teams who deliver care to our members every day. As we embark on another year of service, our partnership based on a common goal will be more important than ever: sustainably providing high-quality, coordinated care. While the total cost of care is often discussed in terms of dollars and cents, it is, in fact, the net result of many clinical decisions made throughout the care continuum. The setting of care, its coor dination and the proactivity of care all have an effect. When care is coordinated, patients receive better care and unnecessary costs decrease accordingly. Not only is the total cost of care not about rationing care or denying access to necessary care, it is also about doing what is most important, in the right setting, at the right time. What are the unnecessary costs of care? All of us are aware of the unnecessary costs of care. These include unnecessary emergency department visits, avoidable hospitalizations, fragmented care within specialties, delays in follow-up care after hospitalization and the lack of care coordination between physical health, behavioral health and social services. Primary care has a key role as the coordinator and anchor of care, while specialists, hospitals, post-acute providers, behavioral health professionals and community partners are equally important in ensuring continuity and alignment. Total cost of care can be improved by more thoughtful referrals, seamless transitions and earlier identication of members with rising or complex needs. As a Chief Medical Ofcer at HAP CareSource, my job is to partner with younot to add to your workload, but to help inform your clinical decisions through collaboration, transparency and shared accountability. In the coming year, our clinical priorities will include improving transitions of care, facilitating care in the right setting, earlier identication of high-risk members and enhancing integration across physical health, behavioral health and community resources. These initiatives are particularly important for the populations we serve together, such as older adults and members with complex medical and social needs. Models of care that focus on integration, such as long-term services and supports and PACE, have shown that integrated care can drive better outcomes while stabilizing the total cost of care. I will write more about these models in the future. As we continue forward, I encourage you to ask yourself a simple question in your daily work: Is this care helping the patient achieve the best possible outcome in the most appropriate setting? When we all focus on that question, quality, experience and sustainability naturally follow. Thank you for your continued partnership and dedication to HAPCareSource members. I look forward to the work ahead. With Gratitude, Dr. Lori Billis Market Medical Director HAP CareSource2UPDATES Network Notication Bulletin HAP CareSource regularly communicates operational updates on our website. Our goal is to keep you updated with a format that is quickly accessible and that keeps you informed about working with us. Here were some network notications posted from the previous quarter that you may have missed: Update of Pharmacy Drug Coverage for Treatment of ObesityDelta Dental PoliciesTelehealth and Remote Patient MonitoringNetwork notications can be accessed at HAPCareSource.com > Providers > Updates & Announcements. HAP CareSource would also like to remind you of our electronic policy postings, conveniently packaging medical, pharmacy, r eimbursement and administrative policy updates into a monthly network notication for your review. You can also nd our provider policies listed at HAPCareSource.com > Providers > Provider Policies. Find Updates from HAP CareSource Online We strive to make partnering with us simple and easy. Were aware things may change in the way we do business with you and want to communicate these changes to you in an efcient manner. To nd all the latest HAP CareSource news, visit our Updates & Announcements page on the Provider pages of HAPCar eSource.com. You will nd all the updated regarding the pr eferred drug list (PDL), prior authorization requirements and medical and reimbursement policies. Important Updates Exciting News: Launch of Our New Learning Management System! We are excited to announce the launch of our new Learning Management System (LMS) with HealthPlanResources.com! This user-friendly platform offers a variety of educational resour ces, training modules and interactive courses tailored to your needs, all developed by HAP CareSource. New content is added based on Provider feedback. All providers and staff can now register for HealthPlanResources.com to access comprehensive content that supports your learning jour ney. Whether you need orientation as a new Provider or want to deepen your knowledge of our health plan and industry best practices, HealthPlanResources.com has the tools you need. Register today and visit our Training and Events page for more information and instructions. Explore HealthPlanResources.com now! Pharmacy Updates for Medicaid HAP CareSource has a searchable drug list that is updated monthly on the website. To nd out which drugs are covered under your plan, go to the Find My Prescriptions link under Member Tools & Resources. The most current updates can be found there also. If members do not have access to the internet, they can call Member Services for their respective market and plan. HAP CareSource will help members nd out if a medication is covered and how much it will cost. 3 For more information, visit HAPCareSource.com The KED Measure: Kidney Health Evaluation for Patients with Diabetes Diabetic nephropathy is a leading cause of kidney failure. It is estimated that approximately 30-40% of people with diabetes will develop some form of kidney damage over their lifetime. In the early stages of kidney disease, there may not be noticeable symptoms, but left untreated it can lead to kidney failure. The KED measures intent is to monitor kidney health among adults with diabetes to help identify and prevent the progression of chronic kidney disease. For HEDIS purposes: KED measures the percentage of members 18-85 years of age with diabetes (Type 1 or Type 2) who r eceived a kidney health evaluation, dened by an estimated glomerular ltration rate (eGFR) AND a urine albumin-creatinine ratio (uACR) during the measurement year. The closer the measure, the uACR or the combination of the quantitative urine albumin lab test and urine creatinine lab test can be order ed in addition to the eGFR. Pertinent CPT and LOINC codes are provided in the chart below.eGFR Test Code Code System 80069 CPT 80050 CPT 80048 CPT 80047 CPT 80053 CPT 82565 CPT 98980-6 LOINC 98979-8 LOINC 94677-2 LOINC 77147-7 LOINC 70969-1 LOINC 69405-9 LOINC 62238-1 LOINC 50384-7 LOINC 50210-4 LOINC 50044-7 LOINC AND uACR Test Code Code System 9318-7 LOINC 89998-9 LOINC 77254-1 LOINC 77253-3 LOINC 76401-9 LOINC 59159-4 LOINC 44292-1 LOINC 30000-4 LOINC 14959-1 LOINC 14958-3 LOINC 13705-9 LOINC OR Quantitative Urine Albumin Lab Test Code Code System 82043 CPT 89999-7 LOINC 57369-1 LOINC 53531-0 LOINC 53530-2 LOINC 43605-5 LOINC 30003-8 LOINC 21059-1 LOINC 1754-1 LOINC 14957-5 LOINC 100158-5 LOINC AND Urine Creatinine Lab Test Code Code System 82570 CPT 58951-5 LOINC 57346-9 LOINC 57344-4 LOINC 39982-4 LOINC 35674-1 LOINC 2161-8 LOINC 20624-3 LOINC Visit Home | National Kidney Foundation of Michigan for information regarding programs such as Diabetes PATH, Diabetes Pr evention Program, Better Choices Better Health and High Blood Pressure Control.4How Do Your Patients Perceive You? Every year, from February through May, CareSource is required to conduct patient experience surveys, such as the Consumer Assessment of Healthcare Providers and Systems (CAHPS ) survey. In this anonymous survey, many of your HAP CareSource patients will be asked questions about their experiences with providers and the health plan. It is the patients chance to voice their opinion. We know your team works hard to provide the best care for every patient on every visit! Our partnership makes a big impact on the patient s perception of their health care experience, and we are here to help. Some things to consider: How would your patients rate the care you provide? Can patient appointments be scheduled easily and as soon as needed? When making a referral, do you inform your patients about how long it will take to get the appointment? Are you working with patients to proactively schedule routine care and screenings? Are your patients aware of your hours and where to go for urgent car e? Will your patients think you are informed and participating in their health care plan? Will your patients think you spent time explaining things, including necessary vaccinations, test processes and results? How would your patients rate how well you listened carefully, showed respect, and spent the needed amount of time with them? We appreciate all that you do and look forward to continuing as your partner in delivering a high standard of car e! CAHPS is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ). PROVIDER S | Spring 2026 Hepatitis Cand Sickle Cell Disease: Removing Barriers for Patients Hepatitis C (Hep C) Studies estimate that over 69,000 Michiganders are currently living with hep C1. Most hep Ccases can be cured in as little as 8-12 weeks2. With the statewide initiative W e Treat Hep C, any provider with prescriptive authority can cure hep C. MAVYRET is preferred and can be dispensed to your HAP CareSource Medicaid or HAP CareSource MI Coordinated Health (HMO D-SNP) patients in extended supplies. Please be sure to indicate total quantity for 8-12 weeks on your prescription and to dispense the full course of treatment at a single time. Sickle Cell Disease (SCD) HAP CareSource has partnered with Michigan Department of Health and Human Services (MDHHS) and the University of Michigan to improve SCD outcomes. We ar e encouraging providers to write 90-day supply prescriptions for hydroxyurea and prophylactic antibiotics for HAP CareSource members, when appropriate. Please notate on the prescription to dispense in a 90-day supply. Here is language to assist: Dispense entire 3-month supplyDo not reconstitute at the pharmacy, please instruct the patient/caregiver on the reconstitution volume and stability so they may r econstitute at home as neededChronic treatment for Sickle Cell DiseaseFor questions or assistance with a pharmacy issue, please contact HAP CareSource at: 1-833-230-2073. References 1. Rosenberg, E.S., Rosenthal, E.M., Hall, E.W., Barker, L., Hofmeister, M.G. Sullivan, P.S., Dietz, P., Mermin, J., Ryerson, A.B. (2018). Prevalence of Hepatitis CVirus Infection in U.S. States and the District of Columbia, 2013 to 2016. JAMA Netw Open, 1(8). doi: 10.1001. 5 2. Fierer, D.S. & Wyles, D.L. (2020). Re-treatment of Hepatitis CInfection After Multiple Failures of Direct-Acting Antiviral Therapy. Open Forum Infectious Disease, 7(4). doi: 10.1093 Importance of Proper Documentation Proper documentation is essential to you and your patients. It ensures patients receive services that are reasonable and necessary, supports proper payment of claims and supports favorable medical record review decisions. CMS offers a Documentation Matters Toolkit on the importance of proper documentation. This toolkit provides guidance for medical and behavioral health professionals, instructional videos and electronic health records fact sheets. The toolkit can be found at: Documentation Matters Toolkit | CMS, www .cms.gov/medicare/ medicaid-coordination/states/ dcoumentation-matters-toolkit Health Needs/Risk Assessment (HRA/HNA) Available Through CareSource MyLife Members can complete the HRA/HNA for themselvesor for their childr en or dependentsthrough their CareSource MyLife account. The assessment is available online at MyLife.CareSource.com/Assess, where members enter their rst and last name, date of birth and ID number to get started. Encourage your members to complete their HRA/HNA. Timely completion helps us better understand member needs and connect them with appropriate resour ces, support and care. Members may also be eligible to earn rewards for completing the assessment. Visit MyLife.CareSource.com/Assess to support your members in completing it. Or scan the QR code.For more information, visit HAPCareSource.comYour Practice In-Lieu of Service (ILOS) Food Service Michigan Medicaid and the Medicaid health plans are offering food services to improve members health. Members may qualify for one of these services at no cost. The food service(s) include: Medically Tailored Home Delivered MealDelivered Moms Meals & Jewish Family ServicesProduce PrescriptionHealthy Home Delivered MealsHealthy Food PacksIt is up to the members whether they use a food service if they qualify. Medicaid coverage and access to other medical services will stay the same if you use a food service or choose not to. By providing food services, we will impr ove the overall health of our members. Resulting in less visits to the Emergency Department and Readmissions into the hospital. Food service is for members who have a: Social Risk Factor – at risk for nutritional deciency ornutritional imbalance due to food insecurity, dened as being unable to obtain nutritionally adequate, medically appropriate and/or safe foods. AND Have a Clinical Risk Factor-illness that can be improvedwith a healthy diet, like: Diabetes, congestive heart failure (CHF),chronic obstructive pulmonary disease (COPD), hypertension,human immunodeciency virus (HIV), cancer with malnutrition,sickle cell disease, r enal disease, gestational diabetes or other high-risk perinatal conditions.OR has been discharged from the hospital or a skilled nursing facility within the last 60 days.A referral is required. Must Identify a Social Food insecure risk factor along with a Clinical Factor on the Authorization. Submission is via the Provider Portal. Identifying Behavioral Health Concerns: A Key to Better Patient Outcomes Patients often experience concerns that extend beyond their stated reason for visiting. Behavioral health concerns, including depression and substance use, are among the most common and costly health issues in the United States, yet they frequently go undetected. Many patients do not voluntarily share behavioral health concerns due to stigma, fear, or lack of awareness about how these issues affect their physical health. Others expect their health care provider to initiate screening. Integrating routine behavioral health screenings into standard practice normalizes conversations ar ound mental health, supports early identication of concerns and enables brief interventions and timely referrals. Untreated mental health and substance use can worsen chronic conditions such as diabetes, cardiovascular disease and chronic pain, leading to increased emergency department visits, higher inpatient utilization and greater health care costs. The use of validated screening tools is essential to identifying behavioral health needs and delivering comprehensive, whole person care. The Substance Abuse and Mental Health Services Administration (SAMHSA) r ecommends universal behavioral health screenings for patients and offers evidenced based resources and tools to support providers. To learn more, visit www.samhsa.gov . References: National Institute of Mental Health (NIMH), Integrated Care for Depression Yields Extended Benets, www.nimh.nih.gov/news/science-updates/2025/integra ted-care-for-depression-yields-extended-benets-malawi-study-shows 6 Your Practice HAP CareSource would like to remind you about our website HAPCareSource.com You can nd information on any matter and even download it! Information about HAP CareSources QualityImprovement Program including goals, pr ocesses and outcomes as related to care and service.Information about HAP CareSources PopulationHealth Programs and services, the targeted populations, as well as how members can opt in/out these pr ograms.Information about case management and disease management programs, including how to use the services and how HAP CareSour ce works with practitioners patients in the program.The process to refer members, including discharge planners, to case management and disease management programs.Information about how to obtain or view copies ofHAP CareSour ces adopted clinical practice guidelinesand preventive health guidelines, including those for: – COPD-Perinatal Care-Asthma-Diabetes-ADHD (children) – Depression (adults) – CDC Recommended Immunization Schedule for Persons Ages 0-18 Years-CDC Recommended Immunization Schedule for Persons Over 18 Years of age-Men: Stay Healthy at Any Age – Women: Stay Healthy at Any Age HAP CareSources medical necessity criteria,including how to obtain or view a copy Information about the availability of staff to answer questions about utilization management (UM) issuesHow to access language assistance for members during health encounters including interpreters for sign language.The toll-fr ee number to contact staff regarding UM issuesThe availability of TTY services for membersInformation about how members may obtain language assistance to discuss UM issuesHAP CareSources policy prohibiting nancial incentives for UM decision-makersInformation about HAP CareSources pharmaceutical management procedures including our drug list along with r estrictions and preferences; how to use pharmaceutical management procedures; an explanation of limits and quotas; how practitioners can provide information to support an exception request; and HAP CareSources processes for generic substitution, therapeutic interchange and step-therapyA description of the process to review information submitted to support a practitioners credentialing application, corr ect erroneous information and,upon request, to be informed of the status of the credentialing or re-credentialing applicationHAP CareSources member rights and responsibilities statementStandards for maintaining and sharing member health recordsInformation about the grievance and appeal processincluding, State Fair HearingsIf you have any questions about accessing our website or if you would like mor e information, please call Health Partner Services. The most recent information about HAP CareSource and our services is always available on HAPCareSource.com. 7 For more information, visit HAPCareSource.com P.O. Box 1025 Dayton, Ohio 45401 VISIT US HAPCareSource.com JOIN US Facebook.com/HAPCareSource X.com/HAPCareSource Member Corner The MemberSource newsletter is a great resource to stay up-to-date with health, wellness and plan information for your HAP CareSource patients. To view editions of the MemberSource newsletter, visit HAPCareSource.com > Members > Education > Newsletters. Thank you for your partnership! MI-Multi-P-5327722 2026 HAP CareSource. All Rights Reserved.
___________________________________________________________________________CONSENT FOR PROVIDER TO FILE AN APPEAL ON PATIENT/MEMBERS BEHALFPROVIDER INFORMATION: Provider Name: Provider NPI: Group Name: Phone #: Address, City, State and ZIP: TELL US THE SERVICES YOU WANT TO APPEAL. INCLUDE DATES OF SERVICE*: *Please be sure to give us all the clinical and other support documents needed for the appeal. MEMBER INFO AND CONSENT: I give consent for the provider listed above to file an appeal on my behalf with CareSource. This will be an appeal of the denial of health care services issued by CareSource. These services are described above. I have read this consent or have had it read to me . It has been explained to me so that I understand. Member Name: Member ID: Date of Birth:Address, City, State and ZIP: Phone #:Member Signature: Date: CONSENT FROM A REPRESENTATIVE: The member listed above cannot sign this consent form. This is because of the reason(s) listed below . I consent for the member: If signed by someone other than the member/minor members parent, you must give us a copy of the power of attorney or court document showing you can act on the members behalf. Please fill out the field s below : Representative Name: Phone Number: Relationship to Member: Rep resentative Signature: Date: Witness Name: Witness Signature: Date: NV-MED-M- 5227807
Notice Date: April 17, 2026 To: Ohio Providers From: CareSource Subject: Remittance Advice Service Date Correction Summary CareSource is informing providers of a recently identified system issue involving ECHO, our third-party payment vendor. On April 8, 2026, ECHO experienced a production issue that caused incorrect service dates to appear on certain provider payment documents. ECHO is actively correcting the impacted records. Providers may temporarily see inaccurate service dates until the correction process is complete. What Happened Due to a production issue on April 8: Explanation of Provider Payment (EPPs) displayed a service date defaulted to 01/01/1900 835 Remittance Advice files displayed a service date defaulted to 01/01/2000 This issue impacted payment reporting only and did not affect claim adjudication or payment amounts. Current Status ECHO is actively correcting all impacted EPPs and 835 remittance files. Completion of this corrective activity is expected to be completed by the end of day, Monday, April 20, 2026. Until processing is finalized, providers may continue to see inaccurate service dates on affected records. What Providers Need to Know No action is required from providers at this time Claims were processed and paid correctly Corrected EPPs and 835s will replace impacted versions once updates are complete Providers can obtain the updated Explanation of Provider Payments from the ECHO portal and the CareSource Portal beginning Tuesday, April 21, 2026. Providers can obtain the updated Electronic Remittance Advice (X12 835) from the ECHO portal beginning Tuesday, April 21, 2026. For Providers servicing Ohio Medicaid and MyCare Members, Electronic Remittance Advice will be distributed to your clearinghouse Please do not resubmit claims based solely on the incorrect service date Support and Questions If you have questions regarding this notice or need assistance reviewing payment or remittance information, please contact: CareSource Provider Services: 800-488-0134 Echo Provider Services: 888-834-3511 CareSource Provider Portal: Users-User Login Echo Provider Portal: ECHO Provider Payments-Login We appreciate your understanding and continued partnership as this issue is resolved. Questions? For follow-up questions, please contact the CareSource Provider Services Call Center at 1-800-488-0134, Monday through Friday, 7 a.m. to 8 p.m., Eastern Time (ET). OH-Multi-P-5462240
Notice Date: April 1 7, 2026 To: Indiana Medicaid Providers From: CareSource Subject: Quest BetterDoctor Provider Information Attestation Effective Date: July 1, 2026 Summary Federal guidelines mandate that providers attest their data every 90 days. CareSource has partnered with Quest Analytics to streamline the verification process through its BetterDoctor solution. Impact Beginning July 1, 2026, providers should complete the following steps to attest: 1. You should receive an email or fax from Quest BetterDoctor. 2. Go to: betterdoctor.com/validate.3. Locate the access token on the fax or email you received from Quest BetterDoctor (it is an eight-character alphanumeric code (for example ABC123D4), and it is not case sensitive) . 4. Enter the access token. 5. Click Submit . 6. Verify and update your information using the online tool in the Quest BetterDoctor portal . 7. Larger practices can submit rosters directly to Quest Analytics . Importance Accurate provider directory information helps CareSource connect the right patients to the right provider s. Please be ready to confirm existing information or provide updated details . Providers can expect to be contacted every 90 days for this information. Please ensure that provider information is current and accurately maintained with Indiana Health Coverage Programs (IHCP) prior to requesting any updates in our CareSource database. Kindly note that the attestation process does not replace the requirement to submit provider maintenance changes directly to CareSource through the Provider Portal. Questions? Providers with questions may contact BetterDoctor at support@betterdoctor.com or CareSourceProvider Services at 1-844-607-2831. The Provider Services team is available Monday through Friday from 8 a.m. to 8 p.m. Eastern Time (ET) and 7 a.m. to 7 p.m. Central Time (CT). IN-MED-P-5204067; First Use: 04/06/2026 OMPP Approved: 04/06/2026
Notice Date: April 16, 2026 To: Georgia TRICARE Prime Demo Providers From: CareSource Military & Veterans Subject: Cultural Competency Effective Date: April 16, 2026 Summary At CareSource Military & Veterans , we are committed to creating resources that empower health care providers to meet the diverse needs of their patients while maintaining professionalism and respect. Our mission is to promote positive health outcomes, ensuring that every individual can achieve optimal health by eliminating barriers to care. Cultural Influences on Health Care Delivery Cultural factors, including language, beliefs, values, and behaviors, influence how individuals perceive illness and interact with the health care system. Education, lived experience, and spiritual beliefs may further affect health-related decisions. Recognizing and addressing cultural differences is essential to improving communication, supporting treatment adherence, and reducing the risk of m isunderstanding or non-compliance. Addressing Gaps in Access to Care Differences in access to health care are impacted by unequal social, economic, and environmental conditions. Achieving fairness in access requires the identification and removal of barriers related to race, ethnicity, gender, religion, socioeconomic status , disability, and geographic location. Addressing gaps in access to care promotes improved health outcomes, stronger communities, and a more sustainable health care system. Cultural Competency Resources We recognize our responsibility to provide educational resources that support our providers and community partners ability to deliver effective and culturally appropriate care, helping us reach our goal to reduce and ultimately eliminate the barriers in health care access and optimal health outcomes that adversely affect our members. Providers can access a variety of cultural competency resources: Psych Armor | Military & Veteran Ready: Providers are invited to take part in the Military & Veteran Ready Organization training program to learn about military culture and how to best serve the active duty and retiree communities and their families. After completing the designated pathway of c ourses, individual learners will receive a Military & Veteran Ready digital certificate and badge to demonstrate their commitment to this community (valid for one year). Visit CareSource Military & Veteran Ready Certificate Program for more information.Additional details about available resources are also included in our provider manual. Prevalent Non-English Languages To effectively support our patient population, it is essential to recognize the cultural and linguistic needs of our communities. Here are the top 10 non-English languages spoken by residents in the state of Georgia:
Notice Date: April 16, 2026 To: Florida TRICARE Prime Demo Providers From: CareSource Military & Veterans Subject: Cultural Competency Effective Date: April 16, 2026 Summary At CareSource Military & Veterans , we are committed to creating resources that empower health care providers to meet the diverse needs of their patients while maintaining professionalism and respect. Our mission is to promote positive health outcomes, ensuring that every individual can achieve optimal health by eliminating barriers to care. Cultural Influences on Health Care Delivery Cultural factors, including language, beliefs, values, and behaviors, influence how individuals perceive illness and interact with the health care system. Education, lived experience, and spiritual beliefs may further affect health-related decisions. Recognizing and addressing cultural differences is essential to improving communication, supporting treatment adherence, and reducing the risk of m isunderstanding or non-compliance. Addressing Gaps in Access to Care Differences in access to health care are impacted by unequal social, economic, and environmental conditions. Achieving fairness in access requires the identification and removal of barriers related to race, ethnicity, gender, religion, socioeconomic status , disability, and geographic location. Addressing gaps in access to care promotes improved health outcomes, stronger communities, and a more sustainable health care system. Cultural Competency Resources We recognize our responsibility to provide educational resources that support our providers and community partners ability to deliver effective and culturally appropriate care, helping us reach our goal to reduce and ultimately eliminate the barriers in health care access and optimal health outcomes that adversely affect our members. Providers can access a variety of cultural competency resources: Psych Armor | Military & Veteran Ready: Providers are invited to take part in the Military & Veteran Ready Organization training program to learn about military culture and how to best serve the active duty and retiree communities and their families. After completing the designated pathway of courses, individual learners will receive a Military & Veteran Ready digital certificate and badge to demonstrate their commitment to this community (valid for one year). Visit CareSource Military & Veteran Ready Certificate Program for more information.Additional details about available resources are also included in our provider manual. Prevalent Non-English Languages To effectively support our patient population, it is essential to recognize the cultural and linguistic needs of our communities. Here are the top 10 non-English languages spoken by residents in the state of Florida:
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