Check Eligibility

We recommend that you check member eligibility each time a member presents for services, as member eligibility can fluctuate. Changes in health status such as pregnancy or certain medical conditions may also cause changes in plan eligibility.

Quick Tips: Member Consent

• When you check eligibility on the Provider Portal, you can also determine if a member has granted consent to share sensitive health information (SHI).
• When a member has a sensitive health diagnosis (e.g., treatment for drug/alcohol use, genetic testing, HIV/AIDS, mental health or sexually transmitted diseases), you should verify if the patient has granted consent to share health information. On the Provider Portal, a message displays on the Member Eligibility page if the member has not consented to sharing sensitive health information.
• Please encourage CareSource members who have not consented to complete a HIPAA Authorization Formso that all providers involved in their care can effectively coordinate their care. This form is located on the Forms
• The HIPAA Authorization Formcan also be used to designate a person to speak on the member’s behalf. This designated representative can be a relative, a friend, a physician, an attorney or some other person that the member specifies.