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.

2017	Date
Navigate March 2018 Policy Release	12/28/2017
Navigate CareSource Medicaid Vision Benefit – This notification has been revised. See notification dated 04/18/2018	12/11/2017
Navigate Update on Drug Testing Reimbursement Policy – UPDATE	12/01/2017
Navigate Notice of Change to Cardiac Services Prior Authorization Requirements	11/17/2017
Navigate Upcoming Deadline for Submitting Ohio Medicaid Provider Number Applications	11/17/2017
Navigate Enhanced Ambulatory Patient Groups (EAPG) Billing Methodology Supersedes CareSource Payment Policies	11/07/2017
Navigate December 2017 Policy Release	11/01/2017
Navigate Diagnosis Related Group Rate Changes	10/24/2017
Navigate Update Regarding Enhanced Ambulatory Patient Group (EAPG) Billing Payment Methodology	10/10/2017
Navigate November 2017 Policy Release	09/28/2017
Navigate PY-0101 - Genetic Testing- Polymerase Chain Reaction	09/22/2017
Navigate Clinical Appeals Require Member Consent	09/22/2017
Navigate Update on Processing Claims for Enhanced Ambulatory Patient Groups – UPDATE	09/01/2017
Navigate Drug Screening Reimbursement Policy – This notification has been revised. See notification dated 12/01/2017.	08/30/2017
Navigate Update on Claim Configurations for Genetic Testing - Polymerase Chain Reaction – UPDATE	08/17/2017
Navigate Update on Claim Configurations for Genetic Testing - Polymerase Chain Reaction – This notification has been revised. See notification dated 08/17/2017.	08/14/2017
Navigate PY-0020 - Drug Screening Payment Policy – This notification has been revised. See notification dated 08/30/2017.	07/31/2017
Navigate Announcing Enforcement of Enhanced Ambulatory Patient Groups Billing Guidelines – This notification has been revised. See notification dated 09/01/2017.	07/27/2017
Navigate September 2017 Policy Release	07/27/2017
Navigate Update on Behavioral Health Denials for Code X50	07/26/2017
Navigate Behavioral Health Respite Care Services for Children	07/18/2017
Navigate Blood Lead Testing Recommendations	07/05/2017
Navigate Update on Configurations for Sexually Transmitted Infections Claims	06/23/2017
Navigate July 2017 Policy Releases	05/31/2017
Navigate Retro Prior Authorizations	05/31/2017
Navigate PY-0037, PY-0205 Sexually Transmitted Infections Reimbursement Policy	04/19/2017
Navigate Screening and Surveillance for Colorectal Cancer	04/18/2017
Navigate MM-0034, MM-0079, MM-0080 Gender Dysphoria Medical Policy	04/14/2017
Navigate PY-0206 Hepatitis Panel Payment Policy	04/13/2017
Navigate Update on Claim Configurations for Specialty Codes and Durable Medical Equipment	04/13/2017
Navigate PY-0128 Three-Day Window Payment Policy	04/10/2017
Navigate Cite AutoAuth – Inpatient PA Requests	04/03/2017
Navigate PY-0226, PY-0227, PY-0228 Vitamin D Assay Testing Payment Policy	03/31/2017
Navigate PY-0222, PY-0223, PY-0224 Thyroid Testing Payment Policy	03/31/2017
Navigate PY-0181, PY-0185, PY-0187 Transthoracic Echocardiogram Payment Policy	03/31/2017
Navigate PY-0169, PY-0174, PY-0173 Sleep Studies Payment Policy	03/31/2017
Navigate PY-0163, PY-0167, PY-0168 Non-Invasive Vascular Studies Payment Policy	03/31/2017
Navigate PY-0157 Glycosylated Hemoglobin A1C Payment Policy	03/29/2017
Navigate PY-0001 Global Obstetrical Services Payment Policy	03/29/2017
Navigate PY-0084 Telemedicine Services Payment Policy	03/29/2017
Navigate PY-0004 Preferred Obstetrical Services Payment Policy	03/29/2017
Navigate PY-0020 Drug Screening Payment Policy – This notification has been revised. See notification dated 08/30/2017.	03/20/2017
Navigate Home Health Nursing Code Change	03/15/2017

2016	Date Posted
Navigate Quick Reference Guide for Non-Participating Health Partners – UPDATE	11/02/2016
Navigate Change in OAC and National Medicaid Code Edits	09/09/2016
Navigate Podiatry 10-Day Quantity Limit for Prescribing Opioids	09/08/2016
Navigate New Genetic Testing - Polymerase Chain Reaction Payment Policy	08/25/2016
Navigate Cite AutoAuth Expansion for Inpatient Authorizations	08/23/2016
Navigate Updated Sexually Transmitted Infection Policy	08/19/2016
Navigate Updated Interventional Pain Mgt Policies	08/19/2016
Navigate Zika Virus Benefit Summary	08/19/2016
Navigate Updated EPSDT Claim Acceptance Criteria	07/28/2016
Navigate Suspension of EPSDT Claim Submission Criteria	07/22/2016
Navigate 10-Day Quantity Limit for Prescribing Opioids	07/11/2016
Navigate Notice of Medical Documentation Requirement for Claim Modifiers	06/14/2016
Navigate Spring 2016 Health Partner Education Forums	04/22/2016
Navigate Change in LCD Procedure Code Edits – UPDATE	04/14/2016
Navigate Update on Appropriate Use of G Codes	03/31/2016
Navigate Home Infusion Therapy Prior Authorization Requirements, Pharmacy Criteria and Billing Guidelines	03/25/2016
Navigate Curbing Opioid Overdose with Naloxone – UPDATE	03/14/2016
Navigate Paper Claims Processing: Rendering and Billing NPI Requirements	03/07/2016
Navigate Change in LCD Procedure Code Edits – This notification has been revised. See notification dated 04/14/2016.	03/04/2016
Navigate Update on Billing Guidelines for Healthchek (EPSDT) Claims	02/26/2016
Navigate Additional Dental Handbook Updates for 2016	02/03/2016
Navigate Deadline Extended for Healthchek (EPSDT) Claims Processing Guidelines	01/29/2016
Navigate Change in Behavioral Health Clinical Guidelines	01/20/2016
New Facility Code Edits for Claims – This notification was canceled and removed 03/03/2016.	01/07/2016

2015	Date Posted
Navigate Healthchek (EPSDT) Claims Processing Guidelines	12/31/2015
Navigate MyCare Coordination of Benefits (COB) Change	12/18/2015
Navigate Vision Benefit Change (Transitions Lenses)	12/04/2015
Navigate Dental Handbook Updates for 2016	12/01/2015
Navigate Vision Benefit Change Update	11/18/2015
Navigate Health Partner Network Notification	11/17/2015
Navigate ICD-10 Qualifiers	11/12/2015
Navigate Curbing Opioid Overdose with Naloxone – See notification dated 03/14/2016.	11/03/2015
Navigate Improved Provider Directory! Your help is needed!	10/29/2015
Navigate Quick Reference Guide for Non-Participating Providers – This notification has been revised. See notification dated 11/02/2016.	10/27/2015
Navigate Credentialing Process	10/19/2015
Navigate Vision Benefit Change – See notification dated 11/18/2015.	09/29/2015
Navigate ICD-10 Coding Guidelines Available from CMS	09/16/2015
Navigate Getting Ready for ICD-10	09/09/2015
Navigate New Facility Code Edits for Claims	09/03/2015
Navigate CMS Posts ICD-10-CM and PCS Code Lists	08/13/2015
Navigate CMS and AMA Issue FAQs to Clarify ICD-10 Preparation Guidance	08/06/2015
Navigate Notification of Nurse & Aide Service Rate Modernization Changes	08/03/2015
Navigate Healthcare Clinic at Select Walgreens Now Accepting CareSource Members	07/28/2015
Navigate New Requirements for Corrected Claims Submissions Effective August 20, 2015	07/22/2015
Navigate CMS Creates Countdown Video, Infographic to Ease ICD-10 Transition	07/22/2015
Navigate HealthSpot Locations Open for Ohio Medicaid Members – This notification was rescinded 12/31/15.	07/15/2015
Navigate Home Health and Hospice ICD-10 Coding Training Opportunity	07/15/2015
Navigate CMS and AMA Partner on ICD-10 Preparations	07/10/2015
Navigate CMS Case Studies Available to Explore ICD-10 Concepts	06/11/2015
Navigate CareSource Webinar, CMS Videos and Call Available for ICD-10 Prep	06/04/2015
Navigate Submit Claims Online Through Provider Portal	06/01/2015
Navigate ODM offers ICD-10 Coding Practice Opportunity	05/21/2015
Navigate ICD-10 Readiness Assessment	05/14/2015
Navigate Summary of MyCare Ohio Services Requiring Prior Authorization	05/12/2015
Navigate Revised Clinical Supporting Documentation Policy	05/06/2015
Navigate Road to 10 Resource for ICD-10 Implementation	04/30/2015
Navigate Transition of Care (TOC) for MyCare Extended for Community Mental Health Centers (CMHCs)	04/23/2015
Navigate Pediatric Clinical Guideline	04/15/2015
Navigate Cite Auto Auth	04/13/2015
Navigate Prior Authorization for Pain Management and CPAPs	04/08/2015
Navigate Primary Care Rate Increase (PCRI) Ending	04/08/2015
Navigate ICD-10 Webinars Scheduled	04/06/2015
Navigate ICD-10 Transition Tips	03/30/2015
Navigate Updated Health Partner Dental Handbook Now Online	03/03/2015
Navigate 2015 Ohio Provider Manual Now Available	02/23/2015
Navigate Office of Health Transformation Payment Innovation	02/20/2015
Navigate EDI Submission of Corrected Claims	02/16/2015
Navigate Electronic Submission of Coordination of Benefits (COB) Claims	02/12/2015
Navigate MyCare Coordination of Benefits (COB) Change for Specific Provider Types	02/06/2015
Navigate MyCare Explanation of Payment (EOP) Correction	01/30/2015
Navigate CareSource Dental Provider Updates	01/23/2015
Navigate MyCare Bad Debt Reports	01/15/2015

2014	Date Posted
Navigate ALERT: ICD-10 Transition Webinar	12/15/2014
Navigate UPDATE – ICD-10 Training Needs and Provider Checklist	11/07/2014
Navigate Text4Baby Service Launches for Ohio Medicaid Members	10/28/2014
Navigate MyCare Ohio Enrollment Changes	10/14/2014
Navigate ALERT: MITS Scheduled Downtime October 10 6PM until October 14 6AM	10/08/2014
Navigate Apria Terming as DME Provider	10/03/2014
Navigate CareSource Advantage (HMO SNP) Non-Renewal	10/01/2014
Navigate State of Ohio Clarifies FQHCs, RHCs not Eligible for PRCI	09/29/2014
Navigate 7 Day Follow-up After Hospitalization for Mental Illness	09/19/2014
Navigate Update on Autism in Ohio	08/20/2014
Navigate Primary Care Rate Increase Update	08/13/2014
Navigate MyCare Educational Forums	08/01/2014
Navigate Coordination of Dental/Orthodontics Benefits	07/18/2014
Navigate Ohio Medicaid Pregnancy Test Kit Initiative	07/16/2014
Navigate New Online Interactive Health Risk Assessment for OH Medicaid and CareSource Just4Me Members	07/01/2014
Navigate OH Medicaid Vision Benefit Update	06/24/2014
Navigate Claims Processing: Rendering Provider NPI Requirement	04/08/2014
Navigate Fee Schedule Resources and Links	04/08/2014
Navigate ICD-10 Implementation Delayed One Year	04/07/2014
Navigate Reminder to Refer to Participating Providers	03/19/2014
Navigate ICD-10 OH Medicaid Provider Q&A	03/05/2014
Navigate Influenza CPT Coding Change	02/21/2014
Navigate ICD-10 Provider Readiness Assessment Survey	01/30/2014
Navigate Change to DRG Payment Process	01/17/2014
Navigate New CMS-1500 Claim Form	01/03/2014

2013	Date Posted
Navigate SNP Prior Authorization High Tech Radiology	12/31/2013
Navigate Enhanced Primary Care Payment	12/20/2013
Navigate CareSource Just4Me Resources Available on www.caresource.com	12/19/2013
Navigate ICD-10 OH Medicaid Provider Q&A	12/13/2013
Navigate Americans with Disabilities Act (ADA) Compliance	12/12/2013
Navigate Screening, Brief Intervention, and Referral to Treatment (SBIRT)	12/06/2013
Navigate NEW CareSource Provider E-Communication System	11/21/2013
Navigate New Facility Code Edits for Hospital Claims	11/14/2013
Navigate Quick Reference Guide for Non-Participating Providers	10/21/2013
Navigate ICD-10 Training Needs and Provider Checklist	10/17/2013
Navigate Synagis Prior Authorization Procedure	10/02/2013
Navigate Provider Issue Resolution Process	09/04/2013
Navigate Fibromyalgia Medication Cost Comparison	08/21/2013
Navigate Payment Policies Page Added to www.caresource.com	07/31/2013
Navigate ICD-10 Compliance Requirement effective October 1, 2014	07/12/2013
Navigate Credentialing of Physician Assistants (PAs) and Advanced Practice Nurses (APNs)	07/11/2013
Navigate Health Services Advisory Group (HSAG) Survey Calls	06/24/2013
Navigate Five Things to Know About Ohio Medicaid Changes	06/21/2013
Navigate Specialty Pharmacy Network Reduction	05/20/2013
Navigate Online Drug Formulary Search Tool	05/08/2013
Navigate Pharmacy Tips: Go Generic!	05/07/2013
Navigate Provider Information Maintenance Reminder	04/02/2013
Navigate Short Fill for Oncology Medications, Phase 2	03/29/2013
Navigate Fluoride Varnish Application Code Change	03/20/2013
Navigate Additional Requirements for Fixed Wing and Helicopter Air Ambulance Operators	03/15/2013
Navigate Short Fill for Oncology Medications	03/05/2013
Navigate CareSource Available on Availity Portal	01/23/2013
Navigate Outpatient Facility Claims and Requirements of Modifier 25	01/31/2013

2012	Date Posted
Navigate OutcomesMTM Provides Medication Therapy Management Services for CareSource Advantage – Effective 01/01/13	12/27/12
Navigate CareSource Policy on Co-Surgeons and Modifier -62 Billing and Reimbursement	12/10/12
Navigate CareSource Policies on Facet Joint and/or Joint Nerve Injection and Sacro-iliac Joint Injection	12/03/12
Navigate Non-Par Provider Quick Reference Guide	11/29/12
www.caresource.com is all NEW!	11/26/12
Changes to CareSource Coordination of Benefits (COB) Policy – Effective 11/05/12	11/05/12
Termination of CareSource Advantage Contract; Continuation of CareSource Medicaid Contracts	11/02/12
CareSource Receives NCQA Accreditation	11/02/12
Enhanced Dental Management Portal Functionality and Claims Processing – Effective 11/26/12	10/26/12
Claims Payment and New EFT Enrollment Authorization Agreement Form – Effective 11/26/12	10/26/12
CareSource Now Available on Availity® Portal	10/22/12
Dental Claims Payment and New EFT Enrollment Authorization Agreement Form	10/19/12
CareSource Policy regarding CMS NCD/LCD Policies	10/16/12
Enhanced Providers Who Administer Synagis® (palivizumab) – Effective 11/01/12	10/09/12
Enhanced Dental Management Services and Upcoming Educational Webinars	10/02/12
Electronic Submission of Coordination of Benefits (COB) Claims – Effective 09/17/12	09/17/12
Navigate Post Stabilization Care Services	09/10/12
Easier-to-Use Membership Lists on the Provider Portal	09/07/12
Provider Access Standards – Reminder	08/15/12
Outpatient Reimbursement, Revenue Codes 250, 270, 636 – Effective 08/01/12	07/31/12
Provider Satisfaction Survey – Coming in September	07/27/12
New Medication Therapy Management Program	07/13/12
ODJFS J Codes Covered for ODMH and ODADAS Providers	07/11/12
CareSource Facility Surgical Edit Policy – Rescinded in 2013, see Anesthesia Payment Policy	07/11/12
CareSource Contracting and Credentialing of Physician Assistants	07/11/12
New Coordination of Benefits (COB) Policy – Under Revision 10/10/12	06/25/12
Members Taking Nexium, Dexilant, Aciphex	06/07/12
ODJFS Updated Sterilization and Hysterectomy Forms	06/04/12
CareSource Facility Surgical Edit Policy	05/31/12
Update on Provider ID Numbers and Legacy ID on Claims	04/20/12
NDC Code Requirements for Professional Claims	04/06/12
CareSource MUE Lab Code Policy	04/10/12
Reminder to Submit Appropriate Provider ID Numbers on 5010 Claims	04/06/12
Providers Who Administer Synagis® (palivizumab)	04/05/12
A Quick Reference Guide: Improving the Patient Experience	04/04/12
Care Transition Programs	04/02/12
New Abbott Diabetes Care Program	03/23/12
Updated Timely Filing Rules	03/15/12
New Diabetic Supplier – Abbott Laboratories	02/14/12
Provider/Group Change Request Form Updated	02/03/12
Individual Claim Payment of $500,000 and Higher	01/31/12
Preferred Specialty Pharmacy Provider	01/24/12
Update on 5010 Clearinghouse Claims Transactions and Issues	01/20/12
CareSource Pharmacy Policy on Stolen Controlled Substances	01/19/12

2011	Date Posted
Navigate Tips for 5010 Success: Submit Legacy ID & Correct Remittance Address	12/30/11
Navigate ODJFS/CareSource Reimbursement Changes for 2012	12/22/11
Navigate Radiation Safety and Most Frequently Requested Advanced Imaging Procedures	12/13/11
Navigate New Provider Portal Updates	11/22/11
Navigate Pharmacy Transition Period Reminder	11/15/11
Revised CareSource Venipuncture Policy	10/28/11
Navigate Refraction Policy	10/28/11
Navigate Revised Clinical Supporting Documentation Policy	10/28/11
Navigate Medically Unlikely Edit (MUE) Policy for code 88342	10/28/11
Navigate CareSource Trading Partners Submitting EDI 837 Claims	10/25/11
Navigate Providers Who Administer Synagis® (palivizumab)	10/17/11
Navigate September 26 Check Write Delayed for Paper Checks / EOPs	10/07/11
Navigate New Benefit Limits Feature on the CareSource Provider Portal	09/30/11
Navigate Quick Reference Guide for Non-Participating Providers	09/26/11
Navigate Prescription Drug Coverage Changing for Members of Ohio Medicaid	09/16/11
Navigate Elective Labor and Delivery Prior to 39 Weeks Gestation	09/08/11
Navigate Enhanced Dental Management Services	09/06/11
Navigate Electronic Funds Transfer – Now Available for All Ohio Providers	08/12/11
Navigate CareSource Plan for 5010 Transition	07/26/11
Navigate Ohio Debarred Attestation	07/18/11
Navigate NDC Requirements for Physician Administered Drugs in an Office Setting	07/15/11
Navigate Ohio Passes House Bill 93 on Prescription Drug Abuse	06/27/11
Navigate 3-day Payment Window for Outpatient Svcs Treated as Inpatient Svcs	06/24/11
Navigate Requesting a Contract and Updating Provider Information Changes	06/02/11
Trigger Point Injection Policy	05/25/11
Navigate Facet Joint and/or Joint Nerve Injection Policy	05/25/11
Navigate Epidural Steroid and Selective Transforaminal Epidural Injections	05/24/11
Navigate CareSource Medicaid DME and Modifier Policy	05/23/11
Navigate ODJFS Supports Electronic Health Records Incentive	05/16/11
Navigate PA Changes to Select Specialty Medications and Pain Management Procedures	05/16/11
Navigate Enhanced Find a Doctor online search tool	05/16/11
Navigate Revised Immunization and Administration Billing Policy	05/13/11
Navigate Enhanced Disease Management Program	05/2011
Navigate Member Education Strategies on Smoking Cessation	04/2011
Navigate New PA Changes to Select Specialty Medications and Pain Management Procedures	04/2011
Navigate Clinical Supporting Documentation Policy	04/2011
Navigate New Improved Explanation of Payment Form	04/2011
Navigate CareSource Plan for 5010 Transition	04/2011
Navigate EHR Incentive Program	03/2011
Navigate Updated Panel Closure for Select Provider Types: Podiatrists, Chiropractors	03/2011
Navigate Therapy Billing - Revised	03/2011
Navigate Facility Inpatient Reimbursement – Now Based on Admit Date	03/2011
Navigate CareSource Changes Transportation Vendor for Members	02/2011
Navigate Advanced Imaging Services Need NIA Privileges	02/2011
Navigate Change to Flu Codes for Special Needs Plan (SNP) Members	01/2011
Navigate APN Medicare Pricing/CMS Methodology	01/2011
Navigate APN Medicaid Pricing/ODJFS Methodology	01/2011
Navigate Provider Survey – Going on Now!	01/2011
Navigate Modifier Definitions	01/2011
Navigate CAHPS Survey Results	01/2011
Navigate What Constitutes a Material Change to an Existing Contract	01/2011

2010	Date Posted
Navigate Direct Access for Case Management/member needs now 24/7	12/2010
Navigate Important Reminder on Montgomery County Care Program	12/2010
Navigate CareSource Medical Claim Edit z60 – Not a Primary Diagnosis	12/2010
Navigate Claim Overpayment Recoupment Policy	12/2010
Navigate Multiple Surgery Procedures for Facility and Professional Claim Submissions	12/2010
Navigate Claim Reprocessing Policy due to Systemic Errors	12/2010
Navigate FDA Withdraws Propoxyphene (Darvocet) from the Market	12/2010
Navigate Statewide Coverage for Vision Labs	10/2010
Navigate Panel Closure for Select Provider Types	10/2010
Navigate Claim Overpayment Recoupment Policy	10/2010
Navigate Podiatry Services Policy	10/2010
Navigate CareSource Code Editing	10/2010
Navigate Reprinted September 11, 2010 Explanation of Payment (EOPs)	09/2010
Navigate Timely Filing Revisions	08/2010
Navigate Appealing Sterilization Claims	08/2010
Navigate Prevnar 13 Reimbursement – Backdated from March 18, 2010	08/2010
Navigate Member Benefits Based on Calendar Year	07/2010
Navigate Professional Developmental Testing Services Billing & Reimbursement Policy	07/2010
Navigate Confidential Provider Information and Unsecured Emails	07/2010
Navigate Payment Policy for Evaluation & Management Services Provided During<br />Global Surgery Period	07/2010
Navigate L-code Changes for 2010	07/2010
Navigate Advanced Practice Nurses to be Contracted as Primary Care Providers	05/2010
Navigate Services Requiring Prior Authorization	02/2010
Navigate Top Claim Denials	02/2010
Navigate Corrected Claims	02/2010
Navigate Hemoglobin and HealthChek Screening Visits	02/2010
Navigate Refractive Service Codes	02/2010
Navigate Prior Authorization Waived for Skilled Home Visits	01/2010

2009	Date Posted
Navigate Home Health Agency Pharmacy Benefit Changes	12/2009

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