Claims

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, 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 claims status
  • Minimal staff training or cost

Refer to the provider manual for detailed information to submit claims.

CareSource also partners with Availity to offer electronic claim submission and real-time transactions at no charge through the Availity Portal. You can use the Availity Portal Registration Guide to get signed up.

Traditional Providers, Community Partners and Delegates and Health Homes

CareSource’s traditional providers, community partners and delegates and health homes all may submit claims through the CareSource Provider Portal using online forms. Three types of claims may be submitted:

  • Professional medical office claims
  • Dental claims
  • Institutional claims

For a detailed explanation of how to submit claims using online forms, please see the Network Notification titled “Submit Claims Online Through Provider Portal.”

Waiver Services Providers

MyCare waiver services providers can also submit claims through the Provider Portal, but they do not use the same process as traditional providers, community partners and delegates and health homes. All claims for waiver services reimbursement or appeals for claim denials should be submitted electronically through our Provider Portal.

Instructions for submitting claims and/or appeals for denial of claims can be found on the Provider Portal. You can also review the Waiver Services Claim Entry and Service Plan Training presentation. 

If you are unable to log in to the Provider Portal and access your service plan, use the CMS 1500 Health Insurance Claim form to expedite your claim payment. You can access instructions to complete the form and a list of valid service codes. After you complete the paper claim form, you may either mail it or fax it for processing:

CareSource
Attn: Claims Department
P.O. Box 8730
Dayton, OH 45401-8730
Fax: 937-224-3388

You will use this paper claim process until you can log in to the Provider Portal and access your service plan. 

To ensure that we have the most up-to-date service plan for our MyCare Ohio members, please fax your service plan to 937-487-0936. This number is only for service plans and NOT claim submissions.

Get Paid Electronically

CareSource has partnered with ECHO Health, Inc. to deliver provider payments. ECHO offers three payment options:

  1. Electronic fund transfer (EFT) – preferred
  2. Virtual Card Payment (QuicRemit) – Standard bank and card issuer fees apply*
  3. 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. You can also complete the NavigateECHO enrollment form and fax, email, or mail it back to ECHO.

Questions? Call ECHO Customer Support at 1-888-834-3511.

To prepare for this transition, please register with ECHO by October 25, 2019

For dates of service prior to the transition, register for payment with our current vendor, InstaMed. Complete the NavigateInstaMed enrollment form and fax it back to InstaMed, who will work directly with you to enroll in EFT. You can also enroll with InstaMed online.

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.

Claim Overpayment Recovery Requests and Resources

NavigateOverpayment Recovery Form – Submit this form to offset overpaid claims against a future payment.

High Dollar Claims

Submit this Navigatecover sheet and itemized statement for high dollar claims.