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 90-day grace period in which to make their premium payment. CareSource will continue to process medical claims and pay providers during this grace period. This grace period is not applicable to the initial payment.
After 30 days of nonpayment, the member’s eligibility will be flagged as delinquent on the Provider Portal. Pharmacy benefits are also shut off after 30 days of nonpayment.
If the member brings themselves current within the 90 days, pharmacy benefits will be reinstated and the past-due flag will be removed.
If the member does not make a payment within the 90-day grace period, the member’s coverage will be terminated.
Note: CareSource offers financial protection to providers for the member’s first 30 days of delinquency. Thereafter, if the member is terminated for nonpayment, all monies paid to the provider for months two and three of delinquency will be recovered, and the provider will need to bill the member directly.
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.