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 Grace Period
Members have a federally mandated ninety (90)-day grace period if they are receiving advance premium tax credit (APTC), or a thirty-one (31)-day grace period if they are not receiving APTC in which to make their payment.
- This is not applicable for their initial payment
- For APTC-receiving members, thirty (30) days after their due date CareSource will:
- Flag the member in the eligibility file on the Provider Portal, suspend pharmacy benefits and pend claims rendered
- For non-APTC members, the day after their due date, CareSource will:
- Flag the member in the eligibility file and on the Provider Portal, suspend pharmacy benefits and pend any claims rendered
If members bring their account into good standing before the expiration of the grace period, pharmacy benefits will start again and pended claims will be processed.
Member Termination
After the grace period has expired, the member is terminated for non-payment of premium.
- CareSource will retroactively terminate the member to either the last day of the first month of the grace period (APTC) or the last paid date (non-APTC).
- CareSource will then deny any claims that are pended during the grace period and reserves the right to recover any amounts paid in this period
Member Rights & Responsibilities
As a CareSource provider, you are required to respect the rights of our members. CareSource members are informed of their rights and responsibilities via their member handbook.
Please review our members’ rights and responsibilities and ensure your practice is in compliance.