Providers who wish to contract with CareSource® must first be credentialed. Through credentialing, we check the qualifications and performance of physicians and other health care practitioners. Providers are recredentialed a minimum of every three years and are considered to be recredentialed unless otherwise notified.
Contracting and Recredentialing Process
CareSource credentials providers using guidelines from the Ohio Department of Insurance (ODI) and the National Committee for Quality Assurance (NCQA). Our Vice President/Senior Medical Director is responsible for the credentialing and recredentialing program.
The Ohio Department of Insurance allows the Council for Affordable Quality Healthcare (CAQH) application to be submitted in lieu of the KAPER-1 form. Please provide your CAQH number and National Provider Identifier (NPI) number to CareSource.
Click the Contract Implementation link below, populate the form and attach your CAQH application or add your CAQH number and NPI number in the additional information text box.
You may also choose to fax or send the same information via certified mail.
Fax to: 937-396-3632
Mail to: CareSource
Attn: Contract Implementation
P.O. Box 8738
Dayton, OH 45401-8738
For more information about CAQH, please log on to the CAQH website or call CAQH at 1-888-599-1771.
CareSource is a participating organization with CAQH. Please make sure that we have access to your provider application before you submit your CAQH number as referenced above:
- Log on to CAQH using your account information.
- Select the Authorization tab.
- Make sure CareSource Advantage Zero Premium, CareSource Advantage and CareSource Advantage Plus Ohio are listed as an authorized health plan.
- If not, check the Authorized box to add.
Please also include the following documents:
- Drug Enforcement Administration (DEA) certificate<IN only: and/or Controlled Dangerous Substances (CDS) certificate>
- Malpractice insurance face sheet
- Clinical Laboratory Improvement Awards (CLIA) certificate, if applicable
- Standard Care Agreement (SCA), if an advanced practice nurse
- Supervisory agreement, if a physician assistant
It is essential that all documents are complete and current, or CareSource will discontinue the contracting and credentialing process.
If you have missing or expired documents, the Credentialing staff will send you a letter with instructionsto correct and submit the updated information.
For questions about credentialing, call CareSource at 1-844-679-7865 and follow the prompts to be directed to one of our Credentialing staff. You can leave a detailed message, and one of our staff will return your call within threebusiness days. We can research the status of yourapplication in the credentialing process or what documents might still be needed.
Or, you can find more information about credentialing in our Provider Portal
CareSource is an HMO with a Medicare contract. Enrollment in CareSource Advantage Zero Premium™ (HMO), CareSource Advantage® (HMO), and CareSource Advantage Plus™ (HMO) depends on contract renewal.