Past Updates & Announcements

We strive to make partnering with us simple. We’re aware things may change in the way we do business with you and want to communicate these changes to you in an efficient manner.

Visit the Updates & Announcements page frequently to find all the latest CareSource news. We share updates regarding:

  • Pharmacy information, including our Preferred Drug Lists (PDLs)
  • Medical, pharmacy, reimbursement and administrative policies
  • Authorization requirements as communicated through network notifications below 

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

2017Date
NavigateMarch 2018 Policy Release12/28/2017
NavigateCareSource Medicaid Vision Benefit – This notification has been revised. See notification dated 04/18/201812/11/2017
NavigateUpdate on Drug Testing Reimbursement Policy – UPDATE12/01/2017
NavigateNotice of Change to Cardiac Services Prior Authorization Requirements11/17/2017
NavigateUpcoming Deadline for Submitting Ohio Medicaid Provider Number Applications11/17/2017
NavigateEnhanced Ambulatory Patient Groups (EAPG) Billing Methodology Supersedes CareSource Payment Policies11/07/2017
NavigateDecember 2017 Policy Release11/01/2017
NavigateDiagnosis Related Group Rate Changes10/24/2017
NavigateUpdate Regarding Enhanced Ambulatory Patient Group (EAPG) Billing Payment Methodology10/10/2017
NavigateNovember 2017 Policy Release09/28/2017
NavigatePY-0101 - Genetic Testing- Polymerase Chain Reaction09/22/2017
NavigateClinical Appeals Require Member Consent09/22/2017
NavigateUpdate on Processing Claims for Enhanced Ambulatory Patient Groups – UPDATE09/01/2017
NavigateDrug Screening Reimbursement Policy – This notification has been revised. See notification dated 12/01/2017.08/30/2017
NavigateUpdate on Claim Configurations for Genetic Testing - Polymerase Chain Reaction – UPDATE08/17/2017
NavigateUpdate on Claim Configurations for Genetic Testing - Polymerase Chain Reaction – This notification has been revised. See notification dated 08/17/2017.08/14/2017
NavigatePY-0020 - Drug Screening Payment Policy – This notification has been revised. See notification dated 08/30/2017. 07/31/2017
NavigateAnnouncing Enforcement of Enhanced Ambulatory Patient Groups Billing Guidelines – This notification has been revised. See notification dated 09/01/2017.07/27/2017
NavigateSeptember 2017 Policy Release07/27/2017
NavigateUpdate on Behavioral Health Denials for Code X5007/26/2017
NavigateBehavioral Health Respite Care Services for Children07/18/2017
NavigateBlood Lead Testing Recommendations07/05/2017
NavigateUpdate on Configurations for Sexually Transmitted Infections Claims06/23/2017
NavigateJuly 2017 Policy Releases05/31/2017
NavigateRetro Prior Authorizations05/31/2017
NavigatePY-0037, PY-0205 Sexually Transmitted Infections Reimbursement Policy04/19/2017
NavigateScreening and Surveillance for Colorectal Cancer04/18/2017
NavigateMM-0034, MM-0079, MM-0080 Gender Dysphoria Medical Policy04/14/2017
NavigatePY-0206 Hepatitis Panel Payment Policy04/13/2017
NavigateUpdate on Claim Configurations for Specialty Codes and Durable Medical Equipment04/13/2017
NavigatePY-0128 Three-Day Window Payment Policy04/10/2017
NavigateCite AutoAuth – Inpatient PA Requests04/03/2017
NavigatePY-0226, PY-0227, PY-0228 Vitamin D Assay Testing Payment Policy03/31/2017
NavigatePY-0222, PY-0223, PY-0224 Thyroid Testing Payment Policy03/31/2017
NavigatePY-0181, PY-0185, PY-0187 Transthoracic Echocardiogram Payment Policy03/31/2017
NavigatePY-0169, PY-0174, PY-0173 Sleep Studies Payment Policy03/31/2017
NavigatePY-0163, PY-0167, PY-0168 Non-Invasive Vascular Studies Payment Policy03/31/2017
NavigatePY-0157 Glycosylated Hemoglobin A1C Payment Policy03/29/2017
NavigatePY-0001 Global Obstetrical Services Payment Policy03/29/2017
NavigatePY-0084 Telemedicine Services Payment Policy03/29/2017
NavigatePY-0004 Preferred Obstetrical Services Payment Policy03/29/2017
NavigatePY-0020 Drug Screening Payment Policy – This notification has been revised. See notification dated 08/30/2017.03/20/2017
NavigateHome Health Nursing Code Change03/15/2017
2016Date Posted
NavigateQuick Reference Guide for Non-Participating Health Partners – UPDATE11/02/2016
NavigateChange in OAC and National Medicaid Code Edits09/09/2016
NavigatePodiatry 10-Day Quantity Limit for Prescribing Opioids09/08/2016
NavigateNew Genetic Testing - Polymerase Chain Reaction Payment Policy08/25/2016
NavigateCite AutoAuth Expansion for Inpatient Authorizations08/23/2016
NavigateUpdated Sexually Transmitted Infection Policy08/19/2016
NavigateUpdated Interventional Pain Mgt Policies08/19/2016
NavigateZika Virus Benefit Summary08/19/2016
NavigateUpdated EPSDT Claim Acceptance Criteria07/28/2016
NavigateSuspension of EPSDT Claim Submission Criteria07/22/2016
Navigate10-Day Quantity Limit for Prescribing Opioids07/11/2016
NavigateNotice of Medical Documentation Requirement for Claim Modifiers06/14/2016
NavigateSpring 2016 Health Partner Education Forums04/22/2016
NavigateChange in LCD Procedure Code Edits – UPDATE04/14/2016
NavigateUpdate on Appropriate Use of G Codes03/31/2016
NavigateHome Infusion Therapy Prior Authorization Requirements, Pharmacy Criteria and Billing Guidelines03/25/2016
NavigateCurbing Opioid Overdose with NaloxoneUPDATE03/14/2016
NavigatePaper Claims Processing: Rendering and Billing NPI Requirements03/07/2016
NavigateChange in LCD Procedure Code Edits – This notification has been revised. See notification dated 04/14/2016.03/04/2016
NavigateUpdate on Billing Guidelines for Healthchek (EPSDT) Claims02/26/2016
NavigateAdditional Dental Handbook Updates for 201602/03/2016
NavigateDeadline Extended for Healthchek (EPSDT) Claims Processing Guidelines01/29/2016
NavigateChange in Behavioral Health Clinical Guidelines01/20/2016
New Facility Code Edits for Claims – This notification was canceled and removed 03/03/2016.01/07/2016
2015Date
Posted
NavigateHealthchek (EPSDT) Claims Processing Guidelines12/31/2015
NavigateMyCare Coordination of Benefits (COB) Change12/18/2015
NavigateVision Benefit Change (Transitions Lenses)12/04/2015
NavigateDental Handbook Updates for 201612/01/2015
NavigateVision Benefit Change Update11/18/2015
NavigateHealth Partner Network Notification11/17/2015
NavigateICD-10 Qualifiers11/12/2015
NavigateCurbing Opioid Overdose with NaloxoneSee notification dated 03/14/2016.11/03/2015
NavigateImproved Provider Directory! Your help is needed!10/29/2015
NavigateQuick Reference Guide for Non-Participating Providers – This notification has been revised. See notification dated 11/02/2016.10/27/2015
NavigateCredentialing Process10/19/2015
NavigateVision Benefit ChangeSee notification dated 11/18/2015.09/29/2015
NavigateICD-10 Coding Guidelines Available from CMS09/16/2015
NavigateGetting Ready for ICD-1009/09/2015
NavigateNew Facility Code Edits for Claims09/03/2015
NavigateCMS Posts ICD-10-CM and PCS Code Lists08/13/2015
NavigateCMS and AMA Issue FAQs to Clarify ICD-10 Preparation Guidance08/06/2015
NavigateNotification of Nurse & Aide Service Rate Modernization Changes08/03/2015
NavigateHealthcare Clinic at Select Walgreens Now Accepting CareSource Members07/28/2015
NavigateNew Requirements for Corrected Claims Submissions Effective August 20, 201507/22/2015
NavigateCMS Creates Countdown Video, Infographic to Ease ICD-10 Transition07/22/2015
NavigateHealthSpot Locations Open for Ohio Medicaid Members – This notification was rescinded 12/31/15.07/15/2015
NavigateHome Health and Hospice ICD-10 Coding Training Opportunity07/15/2015
NavigateCMS and AMA Partner on ICD-10 Preparations07/10/2015
NavigateCMS Case Studies Available to Explore ICD-10 Concepts06/11/2015
NavigateCareSource Webinar, CMS Videos and Call Available for ICD-10 Prep06/04/2015
NavigateSubmit Claims Online Through Provider Portal06/01/2015
NavigateODM offers ICD-10 Coding Practice Opportunity05/21/2015
NavigateICD-10 Readiness Assessment05/14/2015
NavigateSummary of MyCare Ohio Services Requiring Prior Authorization05/12/2015
NavigateRevised Clinical Supporting Documentation Policy05/06/2015
NavigateRoad to 10 Resource for ICD-10 Implementation04/30/2015
NavigateTransition of Care (TOC) for MyCare Extended for Community Mental Health Centers (CMHCs)04/23/2015
NavigatePediatric Clinical Guideline04/15/2015
NavigateCite Auto Auth04/13/2015
NavigatePrior Authorization for Pain Management and CPAPs04/08/2015
NavigatePrimary Care Rate Increase (PCRI) Ending04/08/2015
NavigateICD-10 Webinars Scheduled04/06/2015
NavigateICD-10 Transition Tips03/30/2015
NavigateUpdated Health Partner Dental Handbook Now Online03/03/2015
Navigate2015 Ohio Provider Manual Now Available02/23/2015
NavigateOffice of Health Transformation Payment Innovation02/20/2015
NavigateEDI Submission of Corrected Claims02/16/2015
NavigateElectronic Submission of Coordination of Benefits (COB) Claims02/12/2015
NavigateMyCare Coordination of Benefits (COB) Change for Specific Provider Types02/06/2015
NavigateMyCare Explanation of Payment (EOP) Correction01/30/2015
NavigateCareSource Dental Provider Updates01/23/2015
NavigateMyCare Bad Debt Reports01/15/2015
2014Date
Posted
NavigateALERT: ICD-10 Transition Webinar12/15/2014
NavigateUPDATE – ICD-10 Training Needs and Provider Checklist11/07/2014
NavigateText4Baby Service Launches for Ohio Medicaid Members10/28/2014
NavigateMyCare Ohio Enrollment Changes10/14/2014
NavigateALERT: MITS Scheduled Downtime October 10 6PM until October 14 6AM10/08/2014
NavigateApria Terming as DME Provider10/03/2014
NavigateCareSource Advantage (HMO SNP) Non-Renewal10/01/2014
NavigateState of Ohio Clarifies FQHCs, RHCs not Eligible for PRCI09/29/2014
Navigate7 Day Follow-up After Hospitalization for Mental Illness09/19/2014
NavigateUpdate on Autism in Ohio08/20/2014
NavigatePrimary Care Rate Increase Update08/13/2014
NavigateMyCare Educational Forums08/01/2014
NavigateCoordination of Dental/Orthodontics Benefits07/18/2014
NavigateOhio Medicaid Pregnancy Test Kit Initiative07/16/2014
NavigateNew Online Interactive Health Risk Assessment for OH Medicaid and CareSource Just4Me Members07/01/2014
NavigateOH Medicaid Vision Benefit Update06/24/2014
NavigateClaims Processing: Rendering Provider NPI Requirement04/08/2014
NavigateFee Schedule Resources and Links04/08/2014
NavigateICD-10 Implementation Delayed One Year04/07/2014
NavigateReminder to Refer to Participating Providers03/19/2014
NavigateICD-10 OH Medicaid Provider Q&A03/05/2014
NavigateInfluenza CPT Coding Change02/21/2014
NavigateICD-10 Provider Readiness Assessment Survey01/30/2014
NavigateChange to DRG Payment Process01/17/2014
NavigateNew CMS-1500 Claim Form01/03/2014
2013Date
Posted
NavigateSNP Prior Authorization High Tech Radiology12/31/2013
NavigateEnhanced Primary Care Payment12/20/2013
NavigateCareSource Just4Me Resources Available on www.caresource.com12/19/2013
NavigateICD-10 OH Medicaid Provider Q&A12/13/2013
NavigateAmericans with Disabilities Act (ADA) Compliance12/12/2013
NavigateScreening, Brief Intervention, and Referral to Treatment (SBIRT)12/06/2013
NavigateNEW CareSource Provider E-Communication System11/21/2013
NavigateNew Facility Code Edits for Hospital Claims11/14/2013
NavigateQuick Reference Guide for Non-Participating Providers10/21/2013
NavigateICD-10 Training Needs and Provider Checklist10/17/2013
NavigateSynagis Prior Authorization Procedure10/02/2013
NavigateProvider Issue Resolution Process09/04/2013
NavigateFibromyalgia Medication Cost Comparison08/21/2013
NavigatePayment Policies Page Added to www.caresource.com07/31/2013
NavigateICD-10 Compliance Requirement effective October 1, 201407/12/2013
NavigateCredentialing of Physician Assistants (PAs) and Advanced Practice Nurses (APNs)07/11/2013
NavigateHealth Services Advisory Group (HSAG) Survey Calls06/24/2013
NavigateFive Things to Know About Ohio Medicaid Changes06/21/2013
NavigateSpecialty Pharmacy Network Reduction05/20/2013
NavigateOnline Drug Formulary Search Tool05/08/2013
NavigatePharmacy Tips: Go Generic!05/07/2013
NavigateProvider Information Maintenance Reminder04/02/2013
NavigateShort Fill for Oncology Medications, Phase 203/29/2013
NavigateFluoride Varnish Application Code Change03/20/2013
NavigateAdditional Requirements for Fixed Wing and Helicopter Air Ambulance Operators03/15/2013
NavigateShort Fill for Oncology Medications03/05/2013
NavigateCareSource Available on Availity Portal01/23/2013
NavigateOutpatient Facility Claims and Requirements of Modifier 2501/31/2013

2012Date
Posted
NavigateOutcomesMTM Provides Medication Therapy Management Services for CareSource Advantage – Effective 01/01/1312/27/12
NavigateCareSource Policy on Co-Surgeons and Modifier -62 Billing and Reimbursement12/10/12
NavigateCareSource Policies on Facet Joint and/or Joint Nerve Injection and Sacro-iliac Joint Injection12/03/12
NavigateNon-Par Provider Quick Reference Guide11/29/12
www.caresource.com is all NEW!11/26/12
Changes to CareSource Coordination of Benefits (COB) Policy – Effective 11/05/1211/05/12
Termination of CareSource Advantage Contract; Continuation of CareSource Medicaid Contracts11/02/12
CareSource Receives NCQA Accreditation11/02/12
Enhanced Dental Management Portal Functionality and Claims Processing – Effective 11/26/1210/26/12
Claims Payment and New EFT Enrollment Authorization Agreement Form – Effective 11/26/1210/26/12
CareSource Now Available on Availity® Portal10/22/12
Dental Claims Payment and New EFT Enrollment Authorization Agreement Form10/19/12
CareSource Policy regarding CMS NCD/LCD Policies10/16/12
Enhanced Providers Who Administer Synagis® (palivizumab) – Effective 11/01/1210/09/12
Enhanced Dental Management Services and Upcoming Educational Webinars10/02/12
Electronic Submission of Coordination of Benefits (COB) Claims – Effective 09/17/1209/17/12
NavigatePost Stabilization Care Services09/10/12
Easier-to-Use Membership Lists on the Provider Portal09/07/12
Provider Access Standards – Reminder08/15/12
Outpatient Reimbursement, Revenue Codes 250, 270, 636 – Effective 08/01/1207/31/12
Provider Satisfaction Survey – Coming in September07/27/12
New Medication Therapy Management Program07/13/12
ODJFS J Codes Covered for ODMH and ODADAS Providers07/11/12
CareSource Facility Surgical Edit PolicyRescinded in 2013, see Anesthesia Payment Policy07/11/12
CareSource Contracting and Credentialing of Physician Assistants07/11/12
New Coordination of Benefits (COB) Policy – Under Revision 10/10/1206/25/12
Members Taking Nexium, Dexilant, Aciphex06/07/12
ODJFS Updated Sterilization and Hysterectomy Forms06/04/12
CareSource Facility Surgical Edit Policy05/31/12
Update on Provider ID Numbers and Legacy ID on Claims04/20/12
NDC Code Requirements for Professional Claims04/06/12
CareSource MUE Lab Code Policy04/10/12
Reminder to Submit Appropriate Provider ID Numbers on 5010 Claims04/06/12
Providers Who Administer Synagis® (palivizumab)04/05/12
A Quick Reference Guide: Improving the Patient Experience04/04/12
Care Transition Programs04/02/12
New Abbott Diabetes Care Program03/23/12
Updated Timely Filing Rules 03/15/12
New Diabetic Supplier – Abbott Laboratories02/14/12
Provider/Group Change Request Form Updated02/03/12
Individual Claim Payment of $500,000 and Higher01/31/12
Preferred Specialty Pharmacy Provider01/24/12
Update on 5010 Clearinghouse Claims Transactions and Issues01/20/12
CareSource Pharmacy Policy on Stolen Controlled Substances01/19/12

2011Date
Posted
NavigateTips for 5010 Success: Submit Legacy ID & Correct Remittance Address12/30/11
NavigateODJFS/CareSource Reimbursement Changes for 201212/22/11
NavigateRadiation Safety and Most Frequently Requested Advanced Imaging Procedures12/13/11
NavigateNew Provider Portal Updates11/22/11
NavigatePharmacy Transition Period Reminder11/15/11
Revised CareSource Venipuncture Policy10/28/11
NavigateRefraction Policy10/28/11
NavigateRevised Clinical Supporting Documentation Policy10/28/11
NavigateMedically Unlikely Edit (MUE) Policy for code 8834210/28/11
NavigateCareSource Trading Partners Submitting EDI 837 Claims10/25/11
NavigateProviders Who Administer Synagis® (palivizumab)10/17/11
NavigateSeptember 26 Check Write Delayed for Paper Checks / EOPs10/07/11
NavigateNew Benefit Limits Feature on the CareSource Provider Portal09/30/11
NavigateQuick Reference Guide for Non-Participating Providers09/26/11
NavigatePrescription Drug Coverage Changing for Members of Ohio Medicaid09/16/11
NavigateElective Labor and Delivery Prior to 39 Weeks Gestation09/08/11
NavigateEnhanced Dental Management Services09/06/11
NavigateElectronic Funds Transfer – Now Available for All Ohio Providers08/12/11
NavigateCareSource Plan for 5010 Transition07/26/11
NavigateOhio Debarred Attestation07/18/11
NavigateNDC Requirements for Physician Administered Drugs in an Office Setting07/15/11
NavigateOhio Passes House Bill 93 on Prescription Drug Abuse06/27/11
Navigate3-day Payment Window for Outpatient Svcs Treated as Inpatient Svcs06/24/11
NavigateRequesting a Contract and Updating Provider Information Changes06/02/11
Trigger Point Injection Policy05/25/11
NavigateFacet Joint and/or Joint Nerve Injection Policy05/25/11
NavigateEpidural Steroid and Selective Transforaminal Epidural Injections05/24/11
NavigateCareSource Medicaid DME and Modifier Policy05/23/11
NavigateODJFS Supports Electronic Health Records Incentive05/16/11
NavigatePA Changes to Select Specialty Medications and Pain Management Procedures05/16/11
NavigateEnhanced Find a Doctor online search tool05/16/11
NavigateRevised Immunization and Administration Billing Policy05/13/11
NavigateEnhanced Disease Management Program05/2011
NavigateMember Education Strategies on Smoking Cessation04/2011
NavigateNew PA Changes to Select Specialty Medications and Pain Management Procedures04/2011
NavigateClinical Supporting Documentation Policy04/2011
NavigateNew Improved Explanation of Payment Form04/2011
NavigateCareSource Plan for 5010 Transition04/2011
NavigateEHR Incentive Program03/2011
NavigateUpdated Panel Closure for Select Provider Types: Podiatrists, Chiropractors03/2011
NavigateTherapy Billing - Revised03/2011
NavigateFacility Inpatient Reimbursement – Now Based on Admit Date03/2011
NavigateCareSource Changes Transportation Vendor for Members02/2011
NavigateAdvanced Imaging Services Need NIA Privileges02/2011
NavigateChange to Flu Codes for Special Needs Plan (SNP) Members01/2011
NavigateAPN Medicare Pricing/CMS Methodology01/2011
NavigateAPN Medicaid Pricing/ODJFS Methodology01/2011
NavigateProvider Survey – Going on Now!01/2011
NavigateModifier Definitions01/2011
NavigateCAHPS Survey Results01/2011
NavigateWhat Constitutes a Material Change to an Existing Contract01/2011
2010Date
Posted
NavigateDirect Access for Case Management/member needs now 24/712/2010
NavigateImportant Reminder on Montgomery County Care Program12/2010
NavigateCareSource Medical Claim Edit z60 – Not a Primary Diagnosis12/2010
NavigateClaim Overpayment Recoupment Policy12/2010
NavigateMultiple Surgery Procedures for Facility and Professional Claim Submissions12/2010
NavigateClaim Reprocessing Policy due to Systemic Errors12/2010
NavigateFDA Withdraws Propoxyphene (Darvocet) from the Market12/2010
NavigateStatewide Coverage for Vision Labs10/2010
NavigatePanel Closure for Select Provider Types10/2010
NavigateClaim Overpayment Recoupment Policy10/2010
NavigatePodiatry Services Policy10/2010
NavigateCareSource Code Editing10/2010
NavigateReprinted September 11, 2010 Explanation of Payment (EOPs)09/2010
NavigateTimely Filing Revisions08/2010
NavigateAppealing Sterilization Claims08/2010
NavigatePrevnar 13 Reimbursement – Backdated from March 18, 201008/2010
NavigateMember Benefits Based on Calendar Year07/2010
NavigateProfessional Developmental Testing Services Billing & Reimbursement Policy07/2010
NavigateConfidential Provider Information and Unsecured Emails07/2010
NavigatePayment Policy for Evaluation & Management Services Provided During<br />Global Surgery Period07/2010
NavigateL-code Changes for 201007/2010
NavigateAdvanced Practice Nurses to be Contracted as Primary Care Providers05/2010
NavigateServices Requiring Prior Authorization02/2010
NavigateTop Claim Denials02/2010
NavigateCorrected Claims02/2010
NavigateHemoglobin and HealthChek Screening Visits02/2010
NavigateRefractive Service Codes02/2010
NavigatePrior Authorization Waived for Skilled Home Visits01/2010