- Include the member’s name and the CareSource member ID number.
- Include the provider’s name and ID number.
- Include the code(s) and reason why the determination should be reconsidered.
- If you are submitting a timely filing appeal, send proof of the original receipt of the appeal by fax or electronic data interchange (EDI).
- If the appeal is for a clinical edit denial, include supporting documentation to justify reversing the determination.
- Submit written appeals to:
Attn: CTP Health Partner Appeals
P.O. Box 2008
Dayton, OH 45401-2008