We realize that you perform administrative tasks related to patient care on a daily basis.
We’ve consolidated information below to assist you with tasks such as verifying eligibility, making benefit determinations, acting in a manner that recognizes member rights and cultural differences, and considering alternative ways to deliver services.
Providers may bill Healthy Indiana Plan (HIP) members for copayments for outpatient and inpatient services, as well as prescription drugs. Please see the provider manual for more information.
Please note: HIP members do not pay copayments for preventive services.
Regulations state that providers must hold members harmless in the event that CareSource does not pay for a covered service performed by the provider unless CareSource denies prior authorization of the service and the provider notifies the member in writing that the member is financially responsible. This must be done prior to providing the service, and the member must sign and date the notification.
If the CareSource member requests a service not covered by Medicaid, providers may charge the member for the service as long as the member has been told prior to receiving the service that it was not covered.
If the provider does not tell the member that the service is not covered until after it has been rendered, the provider cannot bill the member.
In compliance with federal and state requirements, CareSource members cannot be billed for missed appointments. CareSource encourages members to keep scheduled appointments and call to cancel, if needed.
Please call our Care Management department at 1-844-607-2831 if you are concerned about a CareSource member who misses appointments.
Please call Provider Services for guidance before billing members for any services. You can reach Provider Services at 1-844-607-2831.
Member Rights & Responsibilities
As a CareSource provider, you are required to respect the rights of our members. CareSource members are informed of their rights and responsibilities via their member handbook. Please review our members’ rights and responsibilities and ensure your practice is in compliance.
When you need to refer patients to a specialty or level of care that is not offered locally, we have a solution.
CareSource covers telemedicine services to members. The coverage is currently limited but expanding as we continue to build partnerships to improve our members’ access to health care across Indiana. Please verify your patient’s coverage before referring a member to telemedicine services.
RIGHT CHOICES PROGRAM (RCP)
The Right Choices Program (RCP) monitors member utilization, and when appropriate, implements restrictions for members who would benefit from increased case coordination. Member utilization review identifies members who use services more than their peers. Any Medicaid member who meets the criteria may be enrolled in RCP. Each RCP member is restricted to a physician, a pharmacy, and/or a hospital. The RCP member’s lock-in physician can refer the member to a specialist. That specialist is then added to the member’s list of providers.
Refer to the Indiana Health Coverage Programs Right Choices Program Reference Module for detailed information on eligibility, claims and other RCP policies.
Providers are encouraged to provide Navigate RCP referrals for all Medicaid services, including carved-out services. This process provides better coordination of care among providers and allows members to obtain prescriptions written by the referral providers at the member’s lock-in pharmacy. Providers must fill out this form and email to the Right Choices Program at Lockinprogram@caresource.com.
If you have any questions you can call Provider Services at 1-800-607-2831.