Patient Administration

We realize that you perform administrative tasks in addition to tasks directly related to patient care.

To assist you with these tasks, we’ve consolidated the information below.

Member Billing

Covered Services

Providers may not bill members for any covered services, with the exception of copayments.

Non-Covered Services

A provider may charge the member for non-covered services unless HAP CareSource denied payment on the basis of medical necessity or the provider’s failure to comply with the terms and conditions of the provider agreement.

In order to charge the member for non-covered services, you must obtain written acknowledgement that the member is assuming financial responsibilities prior to the service being rendered.

Providers may not charge members for services which HAP CareSource denied on the basis of medical necessity or lack of compliance to contractual terms.

Member Rights & Responsibilities

As a HAP CareSource provider, you are required to respect the rights of our members. HAP CareSource members are informed of their rights and responsibilities via their member handbook. Please review our Member Rights and Responsibilities and ensure your practice is in compliance.

EPSDT Guidelines

The Early and Periodic Screening, Diagnostic and Treatment (EPSDT) benefit is designed to ensure that children receive early detection and care so that health problems are averted or diagnosed and treated as early as possible. The benefit includes a comprehensive array of preventive, diagnostic and treatment services for Medicaid eligible infants, children and adolescents under age 21. For more information about EPSDT guidelines, please refer to the Navigate Provider Manual.