These administrative policies apply to Medicare Advantage plans and the MyCare Ohio (Medicare-Medicaid) plan.
Administrative policies offer guidance on determination of medical necessity, investigation and experimental services.
The policies below are in PDF format. If you do not have Adobe Acrobat Reader, you may download it here.
Decision making for Medicare Advantage is based upon the following hierarchy.
NCDs and LCDs can be found at www.CMS.gov. Please refer to the Coverage Determinations for Medicare Advantage policy for additional information on this process. The clinical rationale used by CareSource for making health coverage determinations is available by calling or faxing the CareSource Medical Management Department.