Become a Participating Provider
Ready to join our network? Here’s what comes next.
New Provider Step-by-Step Guide to Become a CareSource Health Partner
Thank you for your interest in becoming a participating CareSource provider.
All providers and provider groups should follow the below step-by-step guide to assist you with this process. If you are unable to follow the below steps, please contact your Health Partner Engagement Specialist for assistance.
Please note: A provider must be fully enrolled and active with Indiana Health Coverage Programs (IHCP) prior to becoming a participating CareSource provider.
Please review the IHCP Network Effective Date Policy for requirements related to the onboarding process for Indiana Medicaid.
Step 1 – Contracting
Contracting is the process of the provider and Managed Care Entity (MCE) formally executing an agreement for the provider to deliver medical services that outlines reimbursement rates, scope of services, etc.
To initiate contracting, please complete the New Health Partner Contracting Form. This form consists of 4 tabs that will need to be completed.
- Tab 1-Instructions: This tab provides instructions guiding you through the completion of tabs 2-4.
- Tab 2-General Information: Please verify that the IRS name entered in tab 2 matches line 1 of your W-9. The IRS name will be used to create your contract.
- Tab 3-Provider(s): Enter both practitioner(s) and facility(ies) data.
- Tab 4-Submission: The following documents are required to be attached within tab 4.
- Signed and dated W-9 Tax Form
- Provider Debarment Form
- Organizational Provider Credentialing Application – required for Ambulatory Surgical Centers, Birthing Centers, Dialysis/End Stage Renal, Opioid Treatment Programs, Urgent Care, Health Departments, Home Health/Home Infusion, Hospital, Hospice, Skilled Nursing Facilities, Rehabilitation Facilities, Orthotic Suppliers, Behavioral Health Facilities (i.e., CMHC/SUD), and Pathology Laboratories.
Notification of an incomplete network participating request will be sent within five business days after receipt of initial request. An incomplete network participation request is defined as a request that CareSource cannot fully process due to missing/illegible documentation or information needed to write a contract.
Fill out the New Health Partner Contract Form to get started.
If you offer medical services and want more information about becoming a participating provider, please submit the New Health Partner Contract Form.
At CareSource, we work with our healthcare providers to ensure the highest quality of care for our members, and we are committed to making it easy for you and your staff to do business with us. Continue watching this module of the Provider Education Series to learn about the CareSource philosophy and process for becoming a new CareSource Health Partner.
Your Application Status
Once you submit your application, you will receive a confirmation email. Please save this email, as it will contain your Application ID.
Please note if contracting one of the following facility types, your request will be forwarded to a health partner contracting manager for processing:
- Hospital (Acute, Behavioral, or Critical Access)
- Skilling Nursing
- Substance Use Disorder
The Office Contact listed on the New Health Partner Contracting form will receive an email from their assigned Health Partner Contract Manager confirming receipt of their participation request. If any additional supporting documentation is needed to create the contract, it will be included in this email.
Step 2 – Get Credentialed
Credentialing refers to process of reviewing the qualifications and appropriateness of a provider to join the health plan’s network.
Providers who wish to contract with CareSource® must also be credentialed. Through credentialing, we check the qualifications and performance of physicians and other health care practitioners. Providers are recredentialed a minimum of every three years and are considered to be recredentialed unless otherwise notified.
Contracting and Recredentialing Process
Credentialing requirements and processes follow NCQA and the Indiana Office of Medicaid Policy and Planning (OMPP) guidelines. OMPP requires that you submit, to CareSource, a complete Council for Affordable Quality Healthcare (CAQH) application or CAQH number, National Provider Identifier (NPI) number and an active Indiana Medicaid ID.
Providers who require credentialing are:
- Practitioners who are licensed, certified, or registered by Indiana Health Coverage Programs (IHCP) to practice independently (without direction or supervision). These provider types may include, but are not limited to: MD, DO, NP, PA, LCSW, DC, PSYD, LMFT, LPCC, etc.
- Practitioners who have an independent relationship with CareSource. An independent relationship is defined when the organization directs its members to see a specific practitioner or group of practitioners, including all practitioners whom members can select as primary care practitioners. These provider types may include, but are not limited to: Family Medicine, Internal Medicine, and Pediatrics.
- Practitioners who provide care to members under CareSource medical benefits, such as Dentists, Oral Maxillofacial Surgeons, Optometrists and Ophthalmologists.
- Some Facilities and Organizational providers who contract with CareSource. These provider types may include, but are not limited to: Hospitals, Home Health Agencies, Skilled Nursing Facilities, Ambulatory Surgery Centers, Urgent Care Facilities, etc.
Providers who practice exclusively within the inpatient hospital setting and provide care for CareSource members only as a result of being directed to the hospital/facility do not need to be credentialed by CareSource unless otherwise noted. These provider types may include hospitalists, pathologists, radiologists, anesthesiologists and emergency room physicians.
Common Credentialing Barriers
CareSource is unable to access your CAQH application.
To grant CareSource authorization please follow these steps:
- Log onto CAQH using your account information.
- Select the authorization tab.
- Make sure CareSource is listed as an authorized plan. If not, check the “Authorized” box to add.
Omission of the following documents within the CAQH application:
- Drug Enforcement Administration (DEA) certificate
- Malpractice insurance face sheet
- Clinical Laboratory Improvement Amendment (CLIA) certificate, if applicable
- Collaborative Practice Agreement, if applicable
All documents must be complete and current
Missing or Expired Documents
If there are missing/expired documents, you will receive a notification letter with instructions to correct and submit the updated information.
Step 3 – Enrollment
Provider enrollment refers to the process of loading a contracted and credentialed provider to all CareSource’s internal systems, loading for claims payment and loading to the provider directory (if applicable). Provider enrollment does not take place until the provider is fully approved and credentialed.
After a provider completes the contracting and credentialing process, CareSource works to load your information into our internal systems. You must complete the full provider enrollment process before you are considered a participating provider with CareSource.
Once the enrollment process is completed and your provider information has been added to the CareSource system and Provider Directory, CareSource will generate a welcome letter within five business days. Your CareSource Welcome Letter will include important information, such as:
- Network Effective Date
- Enrolled Products
- CareSource Provider ID
- Additional instructions for claims submission
- Contact information
Step 4 – Onboarding
Learn how to work with CareSource.
Welcome to the CareSource network! Once you receive your Welcome Letter from CareSource with your CareSource ID number, you have completed the contracting and credentialing process.
As you prepare to see CareSource members, we encourage you to familiarize yourself with our plan, tools and resources.
How to check your application status
You can check your application and credentialing status on the Provider Portal on the “Check Provider Enrollment” page. You will need to enter your NPI and Application ID. Check the Captcha checkbox and then click the “Check Status” button. The tool will allow you to view your status in the contracting, credentialing, and enrollment process as well as specific documents that may still be needed.
Need help? If you have additional general questions about getting contracted, please call CareSource’s Provider Services at 1-844-607-2831 or email us.
We are always looking for ways to improve our network. If you have any suggestions or would like to refer a provider to us, we want to hear from you. Share your ideas or referrals on the Access Opportunity Form.