Check Eligibility

We recommend that you check member eligibility each and every time a member presents for services, as member eligibility can fluctuate.

Quick Tips: Member Consent

• When you check eligibility on the Provider Portal, you can also determine if a member has granted consent to share sensitive health information (SHI).
• When a member has a sensitive health diagnosis (e.g., treatment for drug/alcohol use, genetic testing, HIV/AIDS or sexually transmitted diseases), you should verify if the patient has granted consent to share health information. On the portal, a message displays on the Member Eligibility page if the member has not consented to sharing sensitive health information.
• Please encourage CareSource members who have not consented to complete the Member Consent/HIPAA Authorization form so all providers involved in their care can effectively coordinate their care. This form is located on the Forms page.
• The Member Consent/HIPAA Authorization Form can also be used to designate a person to speak on the member’s behalf.

Advance Payment Tax Credit

Please note: CareSource only applies the 90-day grace period to advance payment tax credit (APTC) eligible members. Members who do not have APTC will have a 31-day grace period. If a member becomes delinquent in premium payments, we will identify this on the Provider Portal. For members receiving APTC, at the end of the first month of the grace period, we will suspend the member’s pharmacy benefits, but continue to pay for medical claims. Members not receiving APTC will lose access to prescription and health services during the grace period. At the end of the grace period, if the member is terminated due to non-payment of a premium, CareSource will recoup any payments made for claims received in the second and third months of the grace period.

See page 41 of the Ohio EOC for additional details on the grace period.