Check Eligibility

Earn rewards for keeping your patients healthy!

Flu shots can keep people healthy and out of the hospital. With so many misconceptions surrounding the flu shot, we need your help to keep CareSource members healthy. To support you, we will be rewarding you $20 for each flu shot you administer to CareSource patients in your practice!


MyCare Ohio allows individuals to opt-out of Medicare coverage from the plan managing their MyCare Ohio benefits. Individuals may choose to have CareSource MyCare Ohio either:

  • Provide their Medicare benefits, or
  • Opt out of the Medicare portion of the program and stay with their current Medicare Advantage plan or traditional Medicare

Providers need to confirm the MyCare Ohio member’s option for Medicare coverage.

Important Tools & Resources
Provider PortalMember ID Card

You can easily verify member eligibility by accessing the Provider Portal or through an eligible Electronic Data Interchange (EDI) clearinghouse.

The CareSource® Dual Advantage (HMO SNP) ID cards display member copays for office visits. The member ID number must be included when billing for services to avoid claim rejection. A detailed view and explanation of the member ID card is available in the Member ID Card Flier.

If a member chooses a different plan for their Medicare benefits, CareSource will only manage Medicaid benefits and will only reimburse claims for Medicaid services. Claims for Medicare must be submitted to the plan managing the member’s Medicare benefits.

Therefore, we recommend that you check member eligibility each and every time a member presents for services, as member eligibility can fluctuate. Changes in health status such as certain medical conditions may also cause changes in plan eligibility and coverage status.

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, mental health or sexually transmitted diseases), you should verify if the patient has granted consent to share health information. On the Provider Portal, a message displays on the Member Eligibility page if the member has not consented to sharing sensitive health information.
  • The Member Consent/HIPAA Authorization Form can also be used to designate a person to speak on the member’s behalf.
  • Please encourage CareSource members who have not consented to complete the Member Consent/HIPAA Authorization Formso that all providers involved in their care can effectively coordinate their care.
Want more information?

For questions not addressed on our website, please call Provider Services at 1-800-488-0134. You can reach us Monday through Friday from 8 a.m. to 6 p.m. Eastern Time (ET)