Save the Date!September 25, 2026 Noon to 1:30 p.m. Eastern Time (ET) /11 a.m. to 12:30 p.m. Central Time (CT) You are invited to the Third Quarterly Friday ForumProvider Friday ForumRegister for the Event here . Agenda: CareSource Q3 2026 Friday Forum: BHIE and SBIRT Time Topic 12:00 p.m. – 12:03 p.m. ET /11:00 a.m. 11:03 a.m. CT Member Enrollment Demographics Snapshot 12:03 p.m. 12:50 p.m . ET/11:03 a.m. 11:50 a.m. CT BHIE and SBIRT 12:50 p.m. 1:30 p.m. ET/11:50 a.m. 12:30 p.m. CT Updates and Announcements Please provide your Provider Engagement Specialist with any topics, discussions, or questions you would like to see highlighted within this presentation. An official invitation will follow. We look forward to your attendance! IN-Multi-P-2903317-V.2; Issued Date: 06/03/2024 OMPP Approved: 06/03 /2024.
DEPRESSIONREFERENCE GUIDEDrug Therapy*Not an exhaustive list of covered depression medications. The above list is intended as a general reference only and should not serve as guidelines for prescribing medications for depression. Please refer to the manufacturers product information sheet or the Prescription Drug Reference (PDR) for any changes in dosage or contraindications. Brand names are registered trademarks.SSRI: Selective Serotonin Reuptake Inhibitors; SNRI: Serotonin and Norepinephrine Reuptake Inhibitors; TCAs: Tricyclic Antidepressants; NDRI: Norepinephrine-Dopamine Reuptake Inhibitor**Please refer to members current formulary for information on member specific covered medications.Commonly Prescribed Antidepressant MedicationsCategory Brand Marketplace Cost: Tier 1 Generic Medications Indications Starting Dose (mg) Usual Daily Dose (mg) for Depression SSRI Fluoxetine(Prozac) $ Depression, Obsessive Compulsive Disorder (OCD) 20 20-80 SSRI Sertraline(Zoloft) $ Depression, Obsessive Compulsive Disorder (OCD) 50 50-200 SSRI Paroxetine(Paxil) $ Depression, Panic Disorder, Obsessive Compulsive Disorder 20 20-50 SSRI Citalopram (Celexa) $ Depression 20 20-40 SSRI Escitalopram(Lexapro) $ Depression, Anxiety 10 5-20 SNRI Venlafaxine(Effexor) $ Depression, Panic 37.5 75-225 SNRI Desvenlafaxine(Pristiq) $ Depression 50 50-100 SNRI Duloxetine(Cymbalta) $ Depression, Anxiety, Fibromyalgia, Neuropathic Pain 20 60-120 NDRI Bupropion(WellbutrinSR. XL) $ Depression, Smoking Cessation 150 SR: 150-400XL: 150-450 TCA Amitriptyline(Elavil) $ Depression 75 75-150 Patient Health Questionnaire (PHQ-9)PHQ-9 Assessment Tool in Management of DepressionSymptomsNone Minimal Mild Moderate Moderately Severe Severe Depression PHQ-9 Score 0-4 5-9 10-14 15-19 20-27 Plan of action and follow-up assessment (CPT 96127) Yearly screening Self-management supportReassess as needed Assess for mania/suicideConsider pharmacotherapyPHQ-9 monthly Assess for mania/suicideInitiate pharmacotherapy and psychotherapy Assess for mania/suicideImmediate pharmacotherapy and psychotherapyConsider mental health specialist referral for treatment failure and severe impairment Source: Patient Health Questionnaire (PHQ) Screeners-Pfizer Helpful Tips & Information: The PHQ-9 tool helps assess symptoms and severity of depression. Additionally, the HAM-D scale can be used before and during treatment. Other screening tools can be used to identify patients who would benefit from drug and/or talk therapy. Educate patients that it may take four to six weeks to see full therapeutic effects of pharmacotherapy. In elderly patients, depression and antidepressant therapy can increase the risk of a fall. Avoid duplication of therapy in patients with newly prescribed antidepressants. Emphasize the importance of medication adherence during the start of treatment and consider extended days supply for maintenance medications where appropriate. Refer patients to community and/or employer sponsored support programs, where available. Please note: For moderate to severe depression, refer to an in-network Behavioral Health (BH) Specialist. Side Effects for Commonly Prescribed Antidepressant Medications: Headache Nausea Constipation Diarrhea Dry mouth Fatigue Sweating Dizziness Vision changes Sexual dysfunction Sleep changes Weight changes (gain and loss) Fall risk in those greater than 65 years old Management of Side Effects Can Include the Following: Educate patients on the difference between adverse effects and depression symptoms. Counsel patients on common side effects (i.e., sexual dysfunction, sedation, fatigue, weight changes). Review patient history, tolerability and therapeutic response to previous therapy. Aim for the lowest effective dose. Change antidepressant medication, dose and schedule where appropriate. Refer to therapy to manage common side effects and improve control of depression symptoms. Monitor and schedule follow-up visits. CareSource Provider ServicesProviders can visit the CareSource provider portal to access additional CareSource resources and information on the following: Provider Network Directory Drug Formulary Behavioral Health Care & Disease Management National Depression Resources & Organizations American Psychological Association (APA) Depression Resources Centers for Disease Control (CDC) Division of Mental Health Patient Health Questionnaire (PHQ-9) National Institute of Mental Health (NIMH) National Alliance on Mental Illness (NAMI) Depression Resources Plans issued by Common Ground Healthcare CooperativeMulti-EXC-P-2416301a-V.1 CareSource 2025. All Rights Reserved.Patient Support988 Suicide & Crisis LifelinePatients or their loved ones can call or text 988 to access a trained crisis counselor 24/7 if they are experiencing a suicidal, substance use and/or mental health crisis; any other kind of emotional distress; or they are worried about a loved one who may need crisis support. For provider or patient pharmacy-related questions, please call the CareSource RX Solutions Center at 1-833-230-2073.If you have a patient who would benefit from our CareSource Marketplace Care Management program,please call 1-833-230-2037 or email us at MarketplaceReferrals@CareSource.com . 24-Hour Nurse Advice LineCareSource offers a 24-Hour Nurse Advice Line that provides around-the-clock access to a caring and experienced staff of registered nurses. Members can call the toll-free number 24 hours a day, seven days a week, 365 days a year. Georgia Marketplace: 1-833-687-7342 (833-NURSEGA)(TTY:711) Indiana Marketplace: 1-866-206-7880 (TTY: 711) Nevada Marketplace: 1-833-687-7378 (TTY: 711) Ohio Marketplace: 1-866-206-4240 (TTY:711) West Virginia Marketplace: 1-866-206-0701 (TTY:711) Wisconsin Marketplace: 1-833-687-7394 (TTY: 711) Resources-Sienaert P. (2014, July 31). Managing the Adverse Effects of Antidepressants. Psychiatric Times. Vol 31 No 7. https://www.psychiatrictimes.com/view/managing-adverse-effects-antidepressants Disclaimer: Recommendation of treatment does not guarantee coverage of services.
Summary of Benefits and Coverage: What this Plan Covers & What You Pay for Covered Services Coverage Period: 01/01/ 2027 12/31/ 2027 CareSource Core Bronze HMO 8500 $50 60224GA001001701 Coverage for: Individual and Family | Plan Type : H MOGASBC27 – Core Bronze 8500 Page 1 of 7The Summary of Benefits and Coverage (SBC) document will help you choose a health plan . The SBC shows you how you and the plan would share the cost for covered health care services. NOTE: Information about the cost of this plan (called the premium ) will be provided separately. This is only a summary. For more information about your coverage, or to get a copy of the complete terms of coverage, contact www.caresource.com/marketplace or call 844-539-1733 . For general definitions of common terms, such as allowed amount , balance billing , coinsurance , copayment , deductible , provider , or other underlined terms , see the Glossary. You can view the Glossary at healthcare.gov/sbc-glossary . Important Questions Answers Why This Matters:What is the overall deductible ?$8,500 individual/$17,000 family per Benefit Year Generally, you must pay all of the costs from providers up to the deductible amount before this plan begins to pay. If you have other family members on the plan , each family member must meet their own individual deductible until the total amount of deductible expenses paid by all family members meets the overall family deductible . Are there services covered before you meet your deductible ? Yes . Preventive care . This plan covers some items and services even if you havent yet met the deductible amount. But a copayment or coinsurance may apply. Are there other deductibles for specific services? No You dont have to meet deductibles for specific services. What is the out-of-pocket limit for this plan ? $11,300 individual/$22,600 family The out-of-pocket limit is the most you could pay in a year for covered services. If you have other family members in this plan , they have to meet their own out-of-pocket limits until the overall family out-of-pocket limit has been met. What is not included in the out-of-pocket limit ? Premiums , balance-billing charges (unless balance billing is prohibited), and health care this plan doesnt cover. Even though you pay these expenses, they dont count toward the out-of-pocket limit . Will you pay less if you use a network provider ? Yes. See www.caresource.com/marketplace or call 844-539-1733 for a list of network providers . This plan uses a provider network . You will pay less if you use a provider in the plans network . You will pay the most if you use an out-of-network provider , and you might receive a bill from a provider for the difference between the providers charge and what your plan pays ( balance billing ). Be aware your network provider might use an out-of-network provider for some services (such as lab work). Check with your provider before you get services. Do you need a referral to see a specialist ? No You can see the specialist you choose without a referral . *For more information about limitations and exceptions, see the plan or policy document a t www.caresource.com/marketplace or call 844-539-1733 . Prior authorization may be required, for more details see www.caresource.com/mp-GA-pa. **Unless specifically listed as after deductible cost shares shown are not subject to the deductible. GASBC27 – Core Bronze 8500 Page 2 of 7 Common Medical Event Services You May Need What You Will Pay ** Limitations , Exceptions , & Other Important Network Provider Information * Network Provider (You will pay the least) Out-of-Network Provider (You will pay the most) If you visit a health care providers office or clinic Teladoc Health $0 Copay Not covered Refer to your Evidence of Coverage Primary care visit to treat an injury or illness . $50 Copay Not covered None Specialist visit $100 Copay Not covered None Preventive care /screening /immunization $0 Copay Not covered Refer to your Evidence of Coverage If you have a test Diagnostic test (x-ray, blood work) X-ray: 50% Coinsurance after deductible Not covered None Lab: 50% Coinsurance after deductible None Imaging (CT/PET scans, MRIs) 50% Coinsurance after deductible Not covered None If you need drugs to treat your illness or condition More information about prescription drug coverage is available at www.caresource.com/marketplace . Preventive $0 Copay Not covered Generic, Preferred Brand and Non – Preferred Brand Drugs: Up to 30-day supply per fill at Retail; up to 90-day supply for Mail Order Specialty Drugs: Up to 30-day supply per fill at Retail and Mail Order Displayed cost share is for a 30-day supply. 90-day supply is available at 2.5 times the cost of a 30-day supply. Preferred generic drugs Up to $25 Copay Not covered Preferred brand drugs 50% Coinsurance after deductible Not covered Non-preferred generic and brand drugs 50% Coinsurance after deductible Not covered Preferred specialty drugs 55% Coinsurance after deductible Not covered Non-preferred specialty drugs 60% Coinsurance after deductible Not covered If you have outpatient surgery Facility fee (e.g., ambulatory surgery center) 50% Coinsurance after deductible Not covered None Physician/surgeon fees 50% Coinsurance after deductible Not covered None *For more information about limitations and exceptions, see the plan or policy document a t www.caresource.com/marketplace or call 844-539-1733 . Prior authorization may be required, for more details see www.caresource.com/mp-GA-pa. **Unless specifically listed as after deductible cost shares shown are not subject to the deductible. GASBC27 – Core Bronze 8500 Page 3 of 7 Common Medical Event Services You May Need What You Will Pay ** Limitations , Exceptions , & Other Important Network Provider Information * Network Provider (You will pay the least) Out-of-Network Provider (You will pay the most) If you need immediate medical attention Emergency room care Facility : 50% Coinsurance after deductible Physician : 50% Coinsurance after deductible Facility: 50% Coinsurance after deductible Physician: 50% Coinsurance after deductible If admitted to the hospital directly from the Emergency Department, these services will be covered the same as inpatient services and the applicable copayment and coinsurance will apply. Emergency medical transportation 50% Coinsurance after deductible 50% Coinsurance after deductible Refer to your Evidence of Coverage Urgent care $75 Copay $75 Copay If you receive services in addition to urgent care , additional copayments , deductibles , or coinsurance may apply. If you have a hospital stay Facility fee (e.g., hospital room) 50% Coinsurance after deductible Not covered None Physician/surgeon fees 50% Coinsurance after deductible Not covered 1 Visit Per Day Per Physician If you need mental health, behavioral health, or substance abuse services Outpatient services $50 Copay for office visits 50% Coinsurance after deductible for other outpatient services Not covered None Inpatient services 50% Coinsurance after deductible Not covered None If you are pregnant Office visits $100 Copay Not covered Cost sharing does not apply for preventive services. Depending on the type of services, coinsurance may apply. Maternity care may include tests and services described elsewhere in the SBC (i.e., ultrasound). Childbirth/delivery professional services 50% Coinsurance after deductible Not covered Childbirth/ delivery facility services 50% Coinsurance after deductible Not covered Your cost for inpatient services only. See above for physician delivery charges. *For more information about limitations and exceptions, see the plan or policy document a t www.caresource.com/marketplace or call 844-539-1733 . Prior authorization may be required, for more details see www.caresource.com/mp-GA-pa. **Unless specifically listed as after deductible cost shares shown are not subject to the deductible. GASBC27 – Core Bronze 8500 Page 4 of 7 Common Medical Event Services You May Need What You Will Pay ** Limitations , Exceptions , & Other Important Network Provider Information * Network Provider (You will pay the least) Out-of-Network Provider (You will pay the most) If you need help recovering or have other special health needs Home health care 50% Coinsurance after deductible Not covered 120 Combined Home Infusion Therapy and Covered Services Visits Per Year. A visit equals 2 hours or less. Rehabilitation services Physical (PT) /Occupational therapy (OT) 50% Coinsurance after deductible Not covered 40 Combined Cognitive Rehabilitative Therapy/MT/OT/PT/ST Visits Per Year Speech therapy (ST) 50% Coinsurance after deductible Not covered 40 Combined Cognitive Rehabilitative Therapy/MT/OT/PT/ST Visits Per Year Post-cochlear implant aural therapy 50% Coinsurance after deductible Not covered See Rehabilitative Speech Therapy All other services 50% Coinsurance after deductible Not covered Refer to your Evidence of Coverage Habilitation services Physical (PT)/Occupational therapy (OT) 50% Coinsurance after deductible Not covered 40 Combined Audiology/MT/OT/PT Visits Per Year Speech therapy (ST) 50% Coinsurance after deductible Not covered 40 Combined Audiology/MT/OT/PT Visits Per Year Audiology 50% Coinsurance after deductible Not covered 40 Combined Audiology/MT/OT/PT Visits Per Year Manipulation therapy (MT) 50% Coinsurance after deductible Not covered 40 Combined Audiology/MT/OT/PT Visits Per Year Skilled nursing care 50% Coinsurance after deductible Not covered 60 Days Per Year Durable medical equipment 50% Coinsurance after deductible Not covered Refer to your Evidence of Coverage Hospice services 50% Coinsurance after deductible Not covered Refer to your Evidence of Coverage *For more information about limitations and exceptions, see the plan or policy document a t www.caresource.com/marketplace or call 844-539-1733 . Prior authorization may be required, for more details see www.caresource.com/mp-GA-pa. **Unless specifically listed as after deductible cost shares shown are not subject to the deductible. GASBC27 – Core Bronze 8500 Page 5 of 7 Common Medical Event Services You May Need What You Will Pay ** Limitations , Exceptions , & Other Important Network Provider Information * Network Provider (You will pay the least) Out-of-Network Provider (You will pay the most) If your child needs dental or eye care Childrens eye exam $0 Copay Not covered 1 Routine Eye Exam Per Year Childrens eyewea r $0 Copay Not covered 1 Pair of Glasses Per Year or 1 Choice of Contact Supply Per Year. Refer to your Evidence of Coverage for more detail. Childrens dental check-up Not covered Not covered Cost sharing shown applies to services received in-person or via telehealthExcluded Services & Other Covered Services :Services Your Plan Generally Does NOT Cover (Check your policy or plan document for more information and a list of any other excluded services .) Abortion (Except in case s of rape, incest, or when the life of the mother is endangered) Acupuncture Bariatric surgery Chiropractic care Dental care Hearing aids Infertility treatment Long-term care Non-emergency care when traveling outside the U.S Private-duty nursing Routine eye care (Adult) Other Covered Services (Limitations may apply to these services. This isnt a complete list. Please see your plan document .) Cosmetic surgery Weight loss programs Routine foot careYour Rights to Continue Coverage: There are agencies that can help if you want to continue your coverage after it ends. The contact information for those agencies is: 1-800-656-2298 . Other coverage options may be available to you , too, including buying individual insurance coverage through the Health Insurance Marketplace Georgia Access . For more information about the Marketplace , visit www.HealthCare.gov or call 1-800-318-2596Georgia Access, visit GeorgiaAccess.gov or call 1-888-687-1503. Your Grievance and Appeals Rights: There are agencies that can help if you have a complaint against your plan for a denial of a claim . This complaint is called a grievance or appeal . For more information about your rights, look at the explanation of benefits you will receive for that medical claim . Your plan documents also provide complete information on how to submit a claim , appeal , or a grievance for any reason to your plan . For more information about your rights, this notice, or assistance, contact: Georgia Department of Insurance : 1-800-656-2298 . Does this plan provide Minimum Essential Coverage? Yes Minimum Essential Coverage generally includes plans , health insurance available through the Marketplace Georgia Access or other individual market policies, Medicare, Medicaid, CHIP, TRICARE, and certain other coverage. If you are eligible for certain types of Minimum Essential Coverage , you may not be eligible for the premium tax credit . *For more information about limitations and exceptions, see the plan or policy document a t www.caresource.com/marketplace or call 844-539-1733 . Prior authorization may be required, for more details see www.caresource.com/mp-GA-pa. **Unless specifically listed as after deductible cost shares shown are not subject to the deductible. GASBC27 – Core Bronze 8500 Page 6 of 7 Does this plan meet the Minimum Value Standards? Not Applicable If your plan doesnt meet the Minimum Value Standards , you may be eligible for a premium tax credit to help you pay for a plan through the Marketplace Georgia Access . Language Access Services: Spanish (Espaol): Para obtener asistencia en Espaol, llame al 844-539-1733 Tagalog (Tagalog): Kung kailangan ninyo ang tulong sa Tagalog tumawag sa 844-539-1733 Chinese ( ): , 844-539-1733 Navajo (Dine): Dinek’ehgo shika at’ohwol ninisingo, kwiijigo holne’ 844-539-1733 . To see examples of how this plan might cover costs for a sample medical situation, see the next section. The plan would be responsible for the other costs of these EXAMPLE covered servicesGASBC27 – Core Bronze 8500 Page 7 of 7 About th ese Coverage Examples : This is not a cost estimator. Treatments shown are just examples of how this plan might cover medical care. Your actual costs will be different depending on the actual care you receive, the prices your providers charge, and many other factors. Focus on the cost-sharing amounts (deductibles , copayments and coinsurance ) and excluded services under the plan . Use this information to compare the portion of costs you might pay under different health plans . Please note these coverage examples a re based on self-only coverage. The plans overall deductible $8,500Specialist Copayment $100 Hospital (facility) Coinsurance 50% Other coinsurance 50% This EXAMPL Eevent includes services like: Specialist office visits (prenatal care) Childbirth/Delivery Professional Services Childbirth/Delivery Facility Services Diagnostic tests (ultrasounds and blood work) Specialist visit (anesthesia) Total Example Cost $12,700 In this example, Peg would pay: Cost Sharing Deductibles $8,500 Copayments $100 Coinsurance $700 What isnt covered Limits or exclusions $60 The total Peg would pay is $9,360 The plans overall deductible $8,500Specialist Copayment $100 Hospital (facility) Coinsurance 50% Other coinsurance 50% This EXAMPL Eevent includes services like: Primary care physician office visits (including disease education) Diagnostic tests (blood work) Prescription drugs Durable medical equipment (glucose meter) Total Example Cost $5,600 In this example, Joe would pay: Cost Sharing Deductibles $4,000 Copayments $700 Coinsurance $0 What isnt covered Limits or exclusions $20 The total Joe would pay is $4,720 The plans overall deductible $8,500Specialist Copayment $100 Hospital (facility) Coinsurance 50% Other coinsurance 50% This EXAMPL Eevent includes services like: Emergency room care (including medical supplies) Diagnostic test (x-ray ) Durable medical equipment (crutches) Rehabilitation services (physical therapy) Total Example Cost $2,800 In this example, Mia would pay: Cost Sharing Deductibles $2,500 Copayments $300 Coinsurance $0 What isnt covered Limits or exclusions $0 The total Mia would pay is $2,800 Peg is Having a Baby(9 months of in-network prenatal care and a hospital delivery) Managing Joes Type 2 Diabetes (a year of routine in-network care of a well – controlled condition) Mias Simple Fracture (in-network emergency room visit and follow up care)
Medicines for schizophrenia can help reduce symptoms, but finding the right one for you may take time. Sometimes people might need to try a few before finding the ones that work best. Some medicines may cause side effects. If that happens, tell your health care provider. They can help! You must take your medicines as prescribed so they work correctly. If not, your symptoms may get worse. To help remind you to take your medicines: Use a pill box Set reminders on phoneTake your medicine at the same time you do other things, like eating lunch or brushing your teeth Set up automatic refills at the pharmacy to make sure you dont run out!If you are still having trouble, ask your provider about long-acting medicines. Make sure you go to all your appointments. Talking with your provider will help you get the right care. Need a Ride to Your Appointments or the Pharmacy? Hoosier Healthwise (HHW) Package A and Healthy Indiana Plan (HIP) members can get unlimited free rides to covered health care visits. And up to five free rides each month to the pharmacy! Please call 1-844-607-2829 (TTY: 1-800-743-3333 or 711) for a ride at least two business days before your visit. If you have questions, call your Care Manager or Member Services. Member Services can be reached at 1-844-607-2829 (TTY: 1-800-743-3333 or 711), 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-M-5323104; First Use: 5/7/2026 OMPP Approved: 5/7/2026 2026 CareSource. All Rights Reserved.Managing Schizophrenia with Medicine
Notice Date: September 3, 2026 To:Nevada Medicaid, Nevada Marketplace, Wisconsin Marketplace* , and West Virginia Marketplace ProvidersFrom: CareSource Subject: Submission Requirements for Uniform Itemized BillsSummary CareSource is committed to accurate, efficient claims processing. Accordingly, all Itemized Bills must comply with the standards below. Compliance helps avoid processing delays and supports timely claim review. Submission Requirements Format Submit itemized bills in text-only format (no images, scans, or handwritten documents). Use MM/DD/YYYY for all dates (e.g., 01/15/2026). Required Information Include the members name, claim ID, date-of-service range ( from and to dates), and total charges. Itemized Bill Structure Present billing details in the following header order: Date, Revenue Code (Rev) , CPT Code, Description , Quantity (Qty) , and Charges. List revenue codes and CPT codes in separate columns. Charges must reconcile at the claim level and within each revenue code grouping. Important Notice Noncompliance may result in processing delays, requests for corrected documentation, or claim denial if discrepancies cannot be resolved. Thank you for your continued cooperation and for helping us maintain efficient claims processing. Questions? If you have questions, please contact CareSource Provider Services at one of the numbers below:Nevada Medicaid: 1-833-230-2112, Monday through Friday, 8 a.m. to 6 p.m. Pacific Time (PT) Nevada Marketplace: 1-833-230-2101, Monday through Friday, 8 a.m. to 6 p.m. PT West Virginia Marketplace: 1-833-230-2101, Monday through Friday, 8 a.m. to 6 p.m. Eastern Time (ET) Wisconsin Marketplace *: 1-833-230-2101, Monday through Friday, 8 a.m. to 6 p.m. ET Thank you for your partnership and for the care you provide for our members. *Plans issued by Common Ground Healthcare Cooperative Multi-Multi-P-5880319
© Copyright CareSource 2026. All rights reserved.
System Details