CareSource® covers dental services for our MyCare Ohio (Medicare-Medicaid Plan) members. Our dental providers can access the following tools to help them provide efficient and quality care.
The CareSource Dental Provider Handbook provides information on topics such as covered services, claims submissions and prior authorization requirements and processes.
Use the following forms for prior authorization requests, claim submissions and more.
- ODJFS Dental Services Prior Authorization Form – Submit this form to the Ohio Department of Job and Family Services (ODJFS) to request prior authorization for dental services.
- ADA Dental Claim Form Instructions – Follow the instructions to fill out the American Dental Association’s (ADA) dental claim form.
- Dental EFT Enrollment Authorization Agreement Form – Follow the instructions to enroll in Scion Dental’s EFT program.
- CareSource TMD Screening Examination Form – Use this screening form to determine evidence of a temporomandibular disorder (TMD) in a patient.
Updates & Announcements
Our goal is to keep you informed with timely information about our plan and services. As changes occur and as needs arise, we issue network notifications to our providers via the Updates & Announcements webpage. Please check this page often to learn about updates and changes than impact your practice.