This provider manual is a resource for working with our health plan. It communicates policies and programs and outlines key information such as claim submission and reimbursement processes, authorizations, member benefits and more to make it easier for you to do business with us.
To view this file, you may need to download Adobe Acrobat Reader.
Updates & Announcements
We continually update information, both on a periodic and an as-necessary basis, and the content of the manual is subject to change without notice. CareSource posts updates through network notifications on the Updates & Announcements page. Please check this webpage often to stay current with all updates.
If you have any questions or would like more information, please call Provider Services at 1-855-202-1058.
Transition of Care
CareSource will coordinate continuity of care for members who have existing care treatment plans that include scheduled services with non-participating health partners or who transition to or from another payer including those members identified as having special health care needs. For continuity of care request approvals, for non-participating primary care providers, 30 days of service will be allowed for the non-participating health partner to transfer care to the network primary care provider.
The provider will have to provide evidence of the authorization of the services from GAMMIS or the method you received verification of services. CareSource will provide an authorization from the date of eligibility with CareSource to the end of the already approved service. The provider will have to submit a request for any additional services for review of medical necessity outside these dates of service prior to transition.
CareSource will need to be contacted via phone at 1-855-202-1058, fax at 1-844-676-0370, or email at firstname.lastname@example.org as there needs to be an authorization in our system that matches the billed services.