Administrative Policies

These administrative policies apply to CareSource® Dual Advantage™ (HMO SNP) plans, and the Medicare Advantage plan.

Administrative policies offer guidance on determination of medical necessity, investigation and experimental services.

The policies below are in PDF format. If you do not have Adobe Acrobat Reader, you may download it here.

Policy Hierarchy

Decision making for CareSource Dual Advantage is based upon the following hierarchy.

DSNP Hierarchy


NCDs and LCDs can be found at Please refer to the Coverage Determinations for Medicare Advantage policy for additional information on this process. The clinical rationale used by CareSource for making health coverage determinations is available by calling or faxing the CareSource Medical Management Department.  

Current Administrative Policies

Archived Administrative Policies