...you, your appointed representative or your physician may request an organization determination. Full details on organization determination requests can be found in the Evidence of Coverage (EOC) (Chapter 9, section...

...regarding payment or benefits to which you believe you are entitled. There are five levels of appeals. Details of all levels can be found in the Evidence of Coverage (Chapter...

...del Afiliado 2023 Evidencia de cobertura (EOC) La Evidencia de cobertura (Evidence of Coverage, EOC) es un documento legal importante que describe la relación existente entre CareSource y los afiliados...

...based on evidence-based care and address the most pressing areas of care. Potential quality measures for Humana – CareSource are: Wellness and Prevention Preventive Screenings (breast cancer, cervical cancer, chlamydia)...

CareSource PASSE™ evaluates prior authorization requests based on medical necessity and benefit limits. Services That Require Prior Authorization Please refer to the Procedure Code Lookup Tool to check whether a...