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 member ID card is used to identify a member; it does not guarantee eligibility or benefits coverage. Members may disenroll from CareSource and retain their previous ID card. Members may lose Medicaid eligibility at any time.
Please note: Indiana members utilize the ID assigned by the state of Indiana and not a unique CareSource subscriber ID.
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 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 webpage.
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.
Notification of Pregnancy (NOP)
Notification of Pregnancy (NOP) is a brief online form created by the Indiana Family & Social Services Administration to facilitate communication between providers and managed care entities (MCEs) such as CareSource. The intention is to help identify risk factors in the earliest stages of pregnancy for women enrolled in Indiana Medicaid programs to improve birth outcomes.CareSource can help provide outreach and support to members throughout pregnancy and beyond to help ensure the best outcomes for mother and baby.To encourage utilization of the NOP process, recognized providers are eligible for a $60 reimbursement for one submitted NOP per managed care member, per pregnancy.
To complete an NOP for a patient, please sign into the Indiana Provider Healthcare Portal at https://portal.indianamedicaid.com, or call the help desk at 1 (800) 457-4584 for more information.
Goals of the NOP include:
- Increase percentage of pregnant women offered services and support during the first trimester.
- Identify and monitor risk factors and outcomes.
- Increase average birth weight of babies.
- Reduce smoking rates for pregnant women.
- Reduce number of pre-term deliveries.
- Improved birth outcomes in Indiana.
- A woman’s pregnancy must be less than 30 weeks gestation at time of office visit.
- The NOP must be submitted within five calendar days from the date of the office visit.
- NOP cannot be submitted on paper.
- Member must be enrolled in MCE through Healthy Indiana Plan (HIP) or Hoosier Healthwise (HHW).
- Presumptive eligible (PE) pregnant women are eligible for this service.
- If a normal pregnancy becomes high risk at any time, providers should use the NOP to document the change.