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Claims 

In addition to information about how to submit claims and check claim 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

Health partners have the option to submit claims through our secure online Provider Portal. CareSource offers this service via our portal at no cost. You can submit claims, check claim status, track payments and more.

We encourage our health partners to submit routine 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 Navigatehealth partner 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 NavigateAvaility Portal Registration Guide to get signed up.

Get Paid Electronically

Great news, CareSource offers Electronic Funds Transfer (EFT) as a payment option!

Simple – Receive fully reconciled remittances electronically; eliminate paper checks and Explanation of Payments (EOPs), which will increase efficiency with payment processing.

Convenient – Available 24/7; works in conjunction with Practice Management systems. In addition, CareSource offers free training for health partners.

Reliable – Claim payments are electronically deposited into your bank account.

Secure –Access your account through CareSource's secure Provider Portal to view (and print if needed) remittances and transaction details.

Simply complete the Navigateenrollment form and fax it back to InstaMed, CareSource's EFT partner, who will work directly with you to enroll in EFT.

Questions? Call Provider Services at 1-844-607-2831.

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 Navigatehealth partner manual for instructions to submit paper claims.

Emergency Room Claims

The following services will be considered emergency room (ER) autopay and processed without a copayment:

  • ER services received after the member calls the 24-hour nurse line and is referred to the ER
  • ER services received based on a referral from the member’s primary medical provider (PMP)
  • Claims received from a provider who has determined the episode of care as emergent and billed it as such according to the Condition Related to Accident or Emergency UB04 indicators

Nonparticipating Providers

Providers who are not in the CareSource network must complete the Nonparticipating Provider Profile Form in order to submit claims. After we receive your profile, you will receive credentials to log in to the Provider Portal, where you can submit claims electronically.