GA Medicaid Prior Authorization Requests

For Cardiac and Musculoskeletal procedures, visit TurningPoint’s website at https://www.myturningpoint-healthcare.com/ to enter Prior Authorization requests.

Provider Portal Alert

There is currently an issue on the Portal that impacts exporting Service Plans. We are working to resolve this issue. We apologize for any inconvenience.

Coming Soon, New Online Claims Submission: A New Look and Feel

Summary
CareSource has updated its Provider Claim Submission feature. The new portal contains all the functionality that is in place today with a new look and feel. You will still have access to the previous functionality, including the features listed below:

Features
Claim Entry Health Insurance Claim Form (HCFA), Uniform Billing (UB) Form, Dental
Claim Entry HCFA, UB, Dental – Partial form save & begin at previous saved location
Claim Entry HCFA, UB, Dental – Recent History
Claim Entry HCFA, UB, Dental – Clone Claim (Full, Partial)
Claim Entry HCFA, UB, Dental – Resubmission
Claim Attachment
Claim Upload – No Direct Data Entry required
Copy a previously submitted claim
Pre-Load Provider Information (NPI, TIN, Billing address and name)
End User Dashboard
Search Capability
Document Status Tracking

Impact
Providers who have saved a draft claim will no longer be able to access that draft once the changes go into effect. Claims previously submitted through our existing Claim Submission feature within the last 45 days cannot be viewed through the new Claims Submission page, but can be viewed on the Provider Portal by searching for a claim by Claim Number.

Importance
There are new user guides and training videos available to help you get familiar with the new Claim Submission feature. These are available on the Provider Portal under Users > Provider Training.

Questions?
If you have any questions or concerns, please contact Provider Services at 1-833-230-2101.

Coming Soon, New Online Claims Submission: A New Look and Feel

Summary
CareSource has updated its Provider Claim Submission feature. The new portal contains all the functionality that is in place today with a new look and feel. You will still have access to the previous functionality, including the features listed below:

Features
Claim Entry Health Insurance Claim Form (HCFA), Uniform Billing (UB) Form, Dental
Claim Entry HCFA, UB, Dental – Partial form save & begin at previous saved location
Claim Entry HCFA, UB, Dental – Recent History
Claim Entry HCFA, UB, Dental – Clone Claim (Full, Partial)
Claim Entry HCFA, UB, Dental – Resubmission
Claim Attachment
Claim Upload – No Direct Data Entry required
Copy a previously submitted claim
Pre-Load Provider Information (NPI, TIN, Billing address and name)
End User Dashboard
Search Capability
Document Status Tracking

Impact
Providers who have saved a draft claim will no longer be able to access that draft once the changes go into effect. Claims previously submitted through our existing Claim Submission feature within the last 45 days cannot be viewed through the new Claims Submission page, but can be viewed on the Provider Portal by searching for a claim by Claim Number.

Importance
There are new user guides and training videos available to help you get familiar with the new Claim Submission feature. These are available on the Provider Portal under Users > Provider Training.

Questions?
If you have any questions or concerns, please contact Provider Services at the appropriate phone
number below:
• D-SNP: 1-833-230-2176
• Marketplace: 1-833-230-2101
• Medicaid: 1-800-488-0134

Coming Soon, New Online Claims Submission: A New Look and Feel

Summary

CareSource has updated its Provider Claim Submission feature. The new portal contains all the functionality that is in place today with a new look and feel. You will still have access to the previous functionality, including the features listed below:

Features
Claim Entry Health Insurance Claim Form (HCFA), Uniform Billing (UB) Form, Dental
Claim Entry HCFA, UB, Dental – Partial form save & begin at previous saved location
Claim Entry HCFA, UB, Dental – Recent History
Claim Entry HCFA, UB, Dental – Clone Claim (Full, Partial)
Claim Entry HCFA, UB, Dental – Resubmission
Claim Attachment
Claim Upload – No Direct Data Entry required
Copy a previously submitted claim
Pre-Load Provider Information (NPI, TIN, Billing address and name)
End User Dashboard
Search Capability
Document Status Tracking

Impact
Providers who have saved a draft claim will no longer be able to access that draft once the changes go into effect. Claims previously submitted through our existing Claim Submission feature within the last 45 days cannot be viewed through the new Claims Submission page, but can be viewed on the Provider Portal by searching for a claim by Claim Number.

Importance
There are new user guides and training videos available to help you get familiar with the new Claim Submission feature. These are available on the Provider Portal under Users > Provider Training.

Questions?
If you have any questions or concerns, please contact Provider Services at 1-833-230-2101.

Attention Providers: Claim Submission Tool Update

Summary

CareSource has updated its Provider Claim Submission feature. The new portal contains all the

functionality that is in place today with a new look and feel. You will still have access to the previous

functionality, including the features listed below:

Features

Claim Entry Health Insurance Claim Form (HCFA), Uniform Billing (UB) Form, Dental

Claim Entry HCFA, UB, Dental – Partial form save & begin at previous saved location

Claim Entry HCFA, UB, Dental – Recent History

Claim Entry HCFA, UB, Dental – Clone Claim (Full, Partial)

Claim Entry HCFA, UB, Dental – Resubmission

Claim Attachment

Claim Upload – No Direct Data Entry required

Copy a previously submitted claim

Pre-Load Provider Information (NPI, TIN, Billing address and name)

End User Dashboard

Search Capability

Document Status Tracking

Impact

Providers who have saved a draft claim will no longer be able to access that draft once the changes go

into effect. Claims previously submitted through our existing Claim Submission feature within the last 45

days cannot be viewed through the new Claims Submission page, but can be viewed on the Provider

Portal by searching for a claim by Claim Number.

Importance

There are new user guides and training videos available to help you get familiar with the new Claim

Submission feature. These are available on the Provider Portal under Users > Provider Training.

Questions?

If you have any questions or concerns, please contact Provider Services at 1-833-230-2101.

Attention Providers: Claim Submission Tool Update

Summary

CareSource has updated its Provider Claim Submission feature. The new portal contains all the

functionality that is in place today with a new look and feel. You will still have access to the previous

functionality, including the features listed below:

Features

Claim Entry Health Insurance Claim Form (HCFA), Uniform Billing (UB) Form, Dental

Claim Entry HCFA, UB, Dental – Partial form save & begin at previous saved location

Claim Entry HCFA, UB, Dental – Recent History

Claim Entry HCFA, UB, Dental – Clone Claim (Full, Partial)

Claim Entry HCFA, UB, Dental – Resubmission

Claim Attachment

Claim Upload – No Direct Data Entry required

Copy a previously submitted claim

Pre-Load Provider Information (NPI, TIN, Billing address and name)

End User Dashboard

Search Capability

Document Status Tracking

Impact

Providers who have saved a draft claim will no longer be able to access that draft once the changes go

into effect. Claims previously submitted through our existing Claim Submission feature within the last 45

days cannot be viewed through the new Claims Submission page, but can be viewed on the Provider

Portal by searching for a claim by Claim Number.

Importance

There are new user guides and training videos available to help you get familiar with the new Claim

Submission feature. These are available on the Provider Portal under Users > Provider Training.

Questions?

If you have any questions or concerns, please contact Provider Services at 1-833-230-2101

Attention Providers: Claim Submission Tool Update

Summary

CareSource has updated its Provider Claim Submission feature. The new portal contains all the

functionality that is in place today with a new look and feel. You will still have access to the previous

functionality, including the features listed below:

Features

Claim Entry Health Insurance Claim Form (HCFA), Uniform Billing (UB) Form, Dental

Claim Entry HCFA, UB, Dental – Partial form save & begin at previous saved location

Claim Entry HCFA, UB, Dental – Recent History

Claim Entry HCFA, UB, Dental – Clone Claim (Full, Partial)

Claim Entry HCFA, UB, Dental – Resubmission

Claim Attachment

Claim Upload – No Direct Data Entry required

Copy a previously submitted claim

Pre-Load Provider Information (NPI, TIN, Billing address and name)

End User Dashboard

Search Capability

Document Status Tracking

Impact

Providers who have saved a draft claim will no longer be able to access that draft once the changes go

into effect. Claims previously submitted through our existing Claim Submission feature within the last 45

days cannot be viewed through the new Claims Submission page, but can be viewed on the Provider

Portal by searching for a claim by Claim Number.

Importance

There are new user guides and training videos available to help you get familiar with the new Claim

Submission feature. These are available on the Provider Portal under Users > Provider Training.

Questions?

If you have any questions or concerns, please contact Provider Services at the appropriate phone number below:

 

Member Portal – Chronic Kidney Disease – MAY

Chronic Kidney Disease

Did you know that 33% of adults in the United States are at risk for chronic kidney disease (CKD)? That’s one in every three. Take the quiz to see if you are at risk.

Increasing Focus on Balance Billing Protection for Members

Member Billing Policy, State and federal regulations prohibit providers from billing CareSource D-SNP and Ohio MyCare members for services provided to them except under limited circumstances.

Process for Billing D-SNP Claims:

  1. Bill Member’s CareSource D-SNP ID # as Medicare primary.
  2. Bill Medicaid (fee for service) as secondary because member has $0 cost sharing.
  3. If a member has CareSource Dual Advantage plan AND CareSource MyCare Opt-out, bill CareSource as secondary with that member’s MyCare ID number.

To help reduce the instances of balance billing, remember the following steps:

Network providers may not balance bill CareSource D-SNP members for covered services. If you have questions regarding billing policies, please reach out to your Health Partner Representative or call Provider Services at 1-833-230-2176 for D-SNP or 1-800-488-0134 for Ohio MyCare.