At CareSource®, everything we do is centered on improving the lives of our members. Our members can receive any medically necessary covered service.
Our Patient Care pages share important policies and procedures that impact CareSource members. Here you will find resources that help us work together to provide the best care for our members.
Please review our resources to the left, designed to help you provide the best care to CareSource members.
- Our Pharmacy page provides information on prescription coverage policies.
- Our Care & Disease Management page provides information on the spectrum of educational and follow-up services designed to help your patients with complex needs navigate their health care.
- Our Behavioral Health page provides resources and information about our behavioral health covered services.
- Our Quality Improvement page provides information on CareSource quality program goals and objectives, access standards and HEDIS® and CAHPS®.
- Our Health Care Links page provides links to clinical and preventive guidelines as well as other resources for various conditions.
Member ID Card and Eligibility
The member ID card is used to identify a member; it does not guarantee eligibility or benefits coverage. Members may disenroll from CareSource and retain their previous ID card. Members may lose Medicaid eligibility at any time.
It is important to verify member eligibility prior to every service. You can easily verify member eligibility by accessing the Provider Portal or through an eligible Electronic Data Interchange (EDI) clearinghouse.
A more detailed view and explanation of the member ID card is available in the CareSource health partner manual.
Notification of Pregnancy (NOP)
Timely identification of risk factors improve birth outcomes. The Notification of Pregnancy (NOP) form has been developed by Indiana Health Coverage Programs (IHCP) to pinpoint risk factors in the earliest stages of pregnancy for women enrolled in Healthy Indiana Plan, Hoosier Healthwise, Hoosier Care Connect, and women participating in the Presumptive Eligibility (PE) program. Recognized providers are eligible for reimbursement for completed NOP’s submitted electronically via the Web interChange.
The submitted information is used by CareSource to determine the risk level associated with the pregnancy and establish areas of follow-up care. For more information, visit the Indiana Medicaid for Providers website.
Member Rights and Responsibilities
As a CareSource health partner, you are required to respect the rights of our members. CareSource members are informed of their rights and responsibilities via their member handbook. You can review our members’ rights and responsibilities here.
Health partners are expected to provide services in a culturally competent manner, which includes removing all language barriers to service and accommodating the unique ethnic, cultural and social needs of the member. Health partners must also meet the requirements of all applicable state and federal laws and regulations.
The CareSource Cultural Competency Plan outlines our commitment to providing culturally-competent services to our members. In addition, Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care provide guidelines for individuals and organizations to implement culturally and linguistically appropriate services:
- Compendium of State-Sponsored National CLAS Standards Implementation Activities – review state governments’ implementation of CLAS standards
- CLAS Training Webinar – learn more about the fundamentals of National CLAS Standards
- CLAS in Action Training Webinar – dive deeper into implementing National CLAS Standards into how you care for patients
- Department of Health and Human Services site – visit the HHS website for more training on cultural competency
CareSource offers sign and language interpreters for members who are:
- Hearing impaired,
- Visually impaired,
- Do not speak English or
- Have limited English-speaking ability.
These services are available at no cost to the member.
As a Medicaid health partner, you are required to identify when your patients need interpretation services and to offer assistance to them as appropriate.
CareSource requires hospitals, at their own expense, to offer sign and language interpreters for members who are hearing impaired, visually impaired or have limited English-speaking ability.
If you do not have access to interpreter services, contact Provider Services at 1-844-607-2831.
CareSource covers telemedicine services to members. The coverage is currently limited but expanding as we continue to build partnerships to improve our members’ access to health care across Indiana. Please verify your patient’s coverage before providing services.
CareSource wants to help members maintain a healthy lifestyle. This includes not using tobacco products. The Tobacco-Free Program aims to increase members’ knowledge of the risks associated with tobacco use and the benefits of cessation. The program provides regular health coaching as well as information on how to obtain pharmacotherapy, from a provider, to assistance with quitting.
Below are links to tobacco cessation resources and training webinars:
- CDC Smoking Cessation Materials – Access CDC resources to help your patients quit smoking. CDC.gov is an online source for credible health information and is the official Web site of the Centers for Disease Control and Prevention (CDC).
- Smokefree.gov Resources for Health Professionals – View evidence-based smoking cessation tools and content from Smokefree.gov. Smokefree.gov provides free, accurate, evidence-based information and professional assistance to help support the immediate and long-term needs of people trying to quit smoking.
Transportation can be provided for member medical appointments; Women, Infants and Children (WIC) appointments; and Medicaid redetermination appointments:
- For Package A members, the non-emergent transportation benefit is limited to 10 round-trip visits (20 one-way trips) of less than 50 miles annually per member for Medicaid. A copayment of $.50 to $3 applies.
- For Package C members, the non-emergent transportation benefit is covered only between medical facilities, when requested by a participating health partner. A copayment of $10 applies.
Note: Healthy Indiana Plan (HIP) members are not covered for non-emergency transportation.
HEDIS® is a registered trademark of the National Committee for Quality Assurance (NCQA).
CAHPS® is a registered trademark of the Agency for Healthcare Research and Quality (AHRQ).