Provider Policies
We maintain medical, payment and administrative policies for our health partners.
These policies are regularly reviewed, updated, withdrawn or added; and therefore, subject to change.
Please check often for updates to health partner policies.
Policies may vary by plan and/or state. Click the links to access policies for your member’s plan.
The policies presented on these pages may not be inclusive of all applicable provider policies. Some benefit management services are provided on behalf of us. Please reference applicable from our delegated service providers.
Providers can view clinical guidelines being used by CareSource at RadMD.com.
Updates & Announcements
Our goal is to keep you informed with timely information about our plan and services. As changes occur and as needs arise, we issue network notifications providers via the CareSource Updates & Announcements page. Please check this page often to learn about updates and changes that impact your practice.
Contact Us
If you have questions, please contact CareSource’s Provider Services at 1-833-230-2176. Our hours of operation are Monday through Friday from 8 a.m. to 6 p.m. Eastern Time (ET).
Note: The policies below are in PDF format. If you do not have Adobe Acrobat Reader, you may download it here.
Administrative
Administrative policies offer guidance for determining medical necessity, investigational and experimental services.
Medical
Medical policies provide guidelines for determining medical necessity and appropriate care for approved benefits.
Pharmacy
Pharmacy policies provide guidelines for coverage of medication.
Reimbursement
Reimbursement policies provide guidance for claim payments.