We recommend that you check member eligibility each and every 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.
You can always verify member eligibility by accessing the Provider Portal or through an eligible Electronic Data Interchange (EDI) clearinghouse.
Member ID Card
The CareSource ID card displays member copays for office visits on the front of the card in the purple box. The suffix at the end of the ID card must be included when billing for services to avoid claim rejection.
A detailed view and explanation of the member ID card is available in the Member ID Card Flier.
When you check eligibility on the Provider Portal, you can also determine if a member has granted consent to share sensitive health information (SHI). SHI is a subset of protected health information (PHI) which may require consent from the individual in order to be shared with others.
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 the Member Consent/HIPAA Authorization Form so that all providers involved in their care can effectively coordinate their care. This form is located on the member Forms page.
The Member Consent/HIPAA Authorization Form can 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.