Provider Policies
These policies are regularly reviewed, updated, withdrawn or added; and therefore, subject to change.
Please check often for updates to health partner policies.
Note: The policies below are in PDF format. If you do not have Adobe Acrobat Reader, you may download it here.
Policies may vary by plan and/or state. Click the links to access policies for your member’s plan.
Medical
Medical policies provide guidelines for determining medical necessity and appropriate care for approved benefits.
Pharmacy
Pharmacy policies provide guidelines for prescription drugs.
Reimbursement
Reimbursement policies provide guidance for claim payments.
Administrative
Administrative policies offer guidance for determining medical necessity, investigational and experimental services.
Musculoskeletal and Cardiac Surgical Procedures
CareSource covers both musculoskeletal and cardiac surgeries for our members. Orthopedic, Neuro-Spine and Cardiac providers can access the following tools to help them provide efficient and quality care.