Check Eligibility

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 easily verify member eligibility by accessing the Provider Portal or through an eligible Electronic Data Interchange (EDI) clearinghouse.

HealthNet

HealthNet is the Commonwealth’s tool for checking member eligibility. HealthNet will display:

  • A member’s plan
  • Current eligibility status
  • If a member is suspended, as well as the reason

Registration is required to sign in to HealthNet.

Member ID Card

The member ID card is used to identify a Humana – CareSource member; it does not guarantee eligibility or benefits coverage. Members may disenroll from Humana – CareSource and retain their previous ID card. Likewise, members may lose Medicaid eligibility at any time. It is important to verify member eligibility prior to every service. You can easily verify member eligibility by accessing the Provider Portal or through an eligible Electronic Data Interchange (EDI) clearinghouse.

A more detailed view and explanation of the member ID card is available in the provider manual.

Newborn Enrollment

Newborns whose mothers are members of the Humana – CareSource Medicaid plan on the newborn’s date of birth normally are covered by Humana – CareSource effective on their date of birth. The newborn’s name will be listed on the primary care provider’s (PCP’s) member eligibility list after it is added to the Humana – CareSource system.

To verify eligibility for a newborn, please go to the Provider Portal and select Member Eligibility. After you enter the mother’s case number from her chart, you should be able to view all eligible members of the household.