Non-Participating Provider Appeals & Disputes

Appeals

Non-participating providers may request reconsideration of a claim denial. You must request an appeal within 60 days of the date of the remittance advice, and a signed Waiver of Liability (WOL) statement is required. If you do not submit a signed WOL, the appeal will be dismissed.

Disputes

CareSource pays non-contracted providers as Medicare would have paid for the same service. Non-contracted providers have the right to request a reconsideration of the plan’s denial of payment:

• Non-contracted providers have 60 calendar days from the remittance notification date to file the reconsideration.
• Non-contracted providers should include documentation such as a copy of the original claim, the remittance notification showing the denial, any clinical records and other documentation that supports the argument for reimbursement.
• Non-contracted providers must mail the reconsideration within 60 calendar days of the explanation of payment (EOP) date or the remittance notification date, whichever is later, to CareSource,
  • Attn: Provider Appeals
    PO Box 1947

    Dayton, OH, 45401-1947

• CareSource will review the evidence and respond to the dispute within 60 calendar days.

For more information, contact Provider Services at 1-844-679-7865.