Claims
Important: Effective Feb. 1, 2023, provider claims submitted to trading partners must include the 12-digit ODM assigned Medicaid member ID (MMIS), else they will be rejected by ODM.
We want to make it as easy as possible to conduct business with us. In addition to information about how to submit claims and check payments, CareSource offers you tools to find specific information, such as claim status and member coordination of benefits (COB) status.
CareSource accepts claims in a variety of formats, including online and paper claims.
Submit Claims Online
Providers have the option to submit claims through our secure, online Provider Portal. You can submit claims (along with any documentation), track claim payments and more. CareSource offers this service at no cost.
We encourage you to submit claims online to take advantage of the following benefits:
- Faster claim processing
- Reduced administrative costs
- Reduced probability of errors or missing information
- Faster feedback on claim status
- Minimal staff training or cost
Refer to the Provider Manual for detailed information to submit claims.
The ability to submit claims through the Provider Portal will no longer be available once the Ohio Department of Medicaid implements Stage 3b.
Get Paid Electronically
CareSource has partnered with ECHO Health, Inc. to deliver provider payments. ECHO offers three payment options:
- Electronic fund transfer (EFT) – preferred
- Virtual Card Payment (QuicRemit) – Standard bank and card issuer fees apply*
- Paper Checks
*Payment processing fees are what you pay your bank and credit card processor for use of payment via credit card.
Enrollment Instructions
Enroll with ECHO for payment and choose EFT as your payment preference for CareSource.
Questions? Call ECHO Customer Support at 1-888-834-3511.
Paper Claims
For the most efficient processing of your claims, CareSource recommends you submit all claims electronically. Paper claim forms are encouraged only for services that require clinical documentation or other forms to process. Refer to the Provider Manual for instructions to submit paper claims.
The ability to submit paper claims will end once Ohio Department of Medicaid (ODM) implements Stage 3b.
Non-Participating Providers
Non-participating providers may submit claims to CareSource using the Non-Participating Provider Profile Form. CareSource is unable to process claims without this information. Please be sure to attach your W-9 form when you submit this online form..
Claim Overpayment Recovery Requests and Resources
Overpayment Recovery Form – Submit this form to offset overpaid claims against a future payment.
Payment Review
Payment Review Tool – Use this tool to reference CareSource’s pre- and post-payment review processes and appropriate contacts.
High Dollar Claims
Submit this cover sheet and itemized statement for high dollar claims.
What you need to know about claim adjudication for February 1
On FeB. 1, 2023, the Electronic Data Interchange (EDI) will launch along with the Fiscal Intermediary (FI) as part of the Next Generation of Ohio Medicaid program. The EDI will be the new exchange point for trading partners on all claims-related activities, providing transparency and visibility regarding care and services. The FI, in conjunction, will assist in routing managed care claims submitted to the EDI, and adjudicate and pay fee-for-service (FFS) claims submitted to the EDI. In preparation for this launch, ODM is providing additional information about claim adjudication.
ODM has moved the 275 attachment submission from Stage 3a to Stage 3b.
Note: When submitting a claim to the new EDI, you will need to submit a 275 attachment via the CareSource Provider Portal. CareSource will continue to accept paper claims and submission of claims to the CareSource Provider Portal until Stage 3b goes live.
Where can you edit managed care claims?
Beginning February 1, all managed care claims submitted by trading partners must be sent to the new EDI. These claims will flow through the FI and route to the appropriate managed care entities (MCE) for processing and payment. CareSource providers who submit managed care claims through direct data entry (DDE) will do so via the CareSource Provider Portal. Edits to claims, including adjustments and voids, should be submitted utilizing the same method (EDI or CareSource Provider Portal) as the original claim submission.
Where will providers go for more information on claims?
All payers’ .pdf remittance advices (RA) will be available to providers on the PNM portal. This includes MITS, FI, and MCO RAs.
If a provider is enrolled with ODM to receive an 835, that enrollment will apply to both FFS and MCO activity. The 835s from all payers will be delivered by the trading partner.
What changes must a provider make when submitting claims via EDI by a trading partner?
If you use a trading partner for processing, you must change the Payer ID for transactions with Date of Service on or after Feb. 1, 2023, as below:
| 837 2010BB NM109 | Description |
|---|---|
| 0003150 | CareSource OH Medicaid Medical |
| CSVIS001 | CareSource OH Medicaid Vision |
| CSDEN001 | CareSource OH Medicaid Dental |