Provider Policies

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CareSource maintains medical, payment and administrative policies for our health partners.

Note: The policies below are in PDF format. If you do not have Adobe Acrobat Reader, you may download it here.


Medical policies provide guidelines for determining medical necessity and appropriate care for approved benefits.


Pharmacy policies provide guidelines for prescription drugs.


Reimbursement policies provide guidance for claim payments.


Administrative policies offer guidance for determining medical necessity, investigational and experimental services.