Claims
Benefits and Services
The Community Transition Program (CTP) provides the following benefits and services.
| Treatment Services (Medicaid-funded except SUD residential treatment) | Recovery Services (Non-Medicaid reimbursement – CTP funded) |
|---|---|
| Diagnostic assessment | Prison in-reach in person (>2 events per year)** |
| Intensive outpatient services (>30 days)* | Prison in-reach via video conference (>4 events per year)** |
| Urinalysis | Support for housing (recovery housing, permanent supporting housing)** |
| Outpatient individual and group | Employment services, job training and education |
| SUD residential treatment | Peer recovery supporter |
| Case management | Transportation (>1 event per month)** |
| Medication Assisted Treatment (MAT) | Life skills |
| Crisis intervention | Relapse prevention |
| Ambulatory detoxification including Naloxone | Spiritual support individual and/or group |
| Identification fund (>2 events per year)** | |
| * Requires prior authorization | **Requires prior approval |
Reimbursement
The CTP provides reimbursement as follows:
- The CTP provides reimbursement for recovery services for individuals enrolled in the program.
- If the CTP member does not have Medicaid, the CTP provides reimbursement for treatment services.
- If the CTP member has Medicaid or other insurance, that plan provides reimbursement for treatment services.
Claims
CareSource encourages providers to submit claims electronically through our secure Provider Portal for the most efficient processing.
Paper claim forms are encouraged for services that require clinical documentation.
Please note: CareSource will accept paper claims starting August 1, 2016.
Use the following identifiers to submit claims.
| If you are a(n)… | Then use… |
|---|---|
| Individual provider billing at the individual level | The individual provider’s Tax ID number and individual provider’s National Provider Identifier (NPI) |
| Individual provider billing at the group level | The group Tax ID number and the individual provider’s NPI |
| Community Mental Health Center billing at the group level | The group NPI |
Electronic Submissions
To submit claims electronically using the Provider Portal, you must work with an electronic claims clearinghouse. CareSource currently accepts electronic claims from Ohio providers through the clearinghouses listed below. Please contact the clearinghouse of your choice to begin electronic claim submissions.
Please provide the clearinghouse with the CareSource payer ID number: 31114.
| Clearinghouse | Phone Number | Website |
|---|---|---|
| Availity (RealMed) | 800-282-4548 | www.availity.com |
| Change Healthcare (Emdeon) | 800-845-6592 | www.changehealthcare.com |
| Dyserv | 614-294-6078 | www.dyserv.com |
| Optum (Netwerkes) | 866-521-8547 | www.optum.com |
| Practice Insight | 832-476-9030 | www.practiceinsight.com |
| Quadax | 440-777-6305 | www.quadax.com |
| RelayHealth | 866-735-2963 | www.relayhealth.com |
| The Consult | 800-327-1213 | www.4ecp.com |
| Zirmed | 877-494-7633 | www.zirmed.com |