Humana – CareSource® covers the same services as traditional fee-for-service Medicaid. Our members do not have co-payments for medical services. In addition to traditional benefits, we cover some adult chiropractic care and private, adult outpatient psychology services.
Members can get many services without a referral from their Primary Care Provider (PCP). They can simply call for an appointment. For more information, please see the Provider Manual - see Referrals and Authorizations.
Members must receive a Prior Authorization from their PCP to receive some services. For more information, please visit the Prior Authorization section. Also, our Covered Services Grid indicates which services require Prior Authorization.
Humana – CareSource partners with HealthHelp to provide consultation of high-tech radiology. RadConsult is HealthHelp’s radiology-centered program providing real-time decision support for physicians considering CT, CTA, MRI, MRA and PET scans as part of a diagnostic work-up. Visit HealthHelp for additional information regarding radiology services.
Managed Care of North America, Inc. (MCNA) is the dental benefits manager for Humana – CareSource. MCNA is a leading dental benefit management company committed to providing high quality services to state agencies and managed care organizations for their Medicaid, Medicare, and Children’s Health Insurance Program (CHIP) members. The MCNA Dental Care Services grid outlines covered services. You can access more information at the MCNA Portal.
Behavioral health and substance abuse services are covered services for Humana – CareSource Members. Humana – CareSource is contracted with Beacon Behavioral Health for the provision of these services. Providers can contact Beacon at 1-855-852-7005 for available behavioral heath and substance abuse benefits. For more information on Behavioral Health Services, see the Behavioral Health section.
For additional questions, please see the Provider Manual.
Members may go to Non-Participating Providers for:
- Emergency care
- Care at community mental health centers
- Family planning services provided at Qualified Family Planning providers (Planned Parenthood)
- Care at Federally Qualified Health Centers (FQHCs)
Humana – CareSource offers its members many benefits and support services. For additional questions regarding benefits, call 1-855-852-7005. These include:
24-Hour Nurse Triage Line
Humana – CareSource offers an in-house, 24-hour nurse triage line for Members to call with medical questions and concerns 24 hours a day, 7 days a week. Our nurses can assess a Member's condition and direct the Member to the most appropriate place for care, whether that is the doctor's office, urgent treatment center, or the emergency room. Members can call Humana – CareSource 24 at 1-866-206-9599 (TTY for the hearing impaired: 1-800-648-6056 or 711).
Care Management / Care Management for High-Risk Members
Humana – CareSource has nurse care managers who assist members with conditions such as asthma, diabetes, congestive heart failure, obesity and high-risk pregnancy in coordinating appropriate medical and support services. If you know of any Humana – CareSource member who may benefit from care management, please call Member Services at 1-855-852-7005 (TTY for the hearing impaired: 1-800-648-6056 or 711).
Humana – CareSource also provides a comprehensive integrated care management model for our highest-risk Members. Utilizing nurses and social workers, this multi-disciplinary approach integrates the Case Management Society of America Standards of Practice to help patients overcome health care access barriers. Typical high-risk Members may have multiple medical issues, socioeconomic challenges and behavioral health care needs.
Humana - CareSource Disease Management Program
Humana – CareSource Medicaid Members with chronic conditions, including asthma and diabetes, will be automatically enrolled into Humana – CareSource’s enhanced disease management program. If you have a Humana – CareSource patient with asthma or diabetes who you believe would benefit from this program and is not already enrolled, call 866-206-0272.
Pregnant Members and new mothers can earn up to $150 in gift certificates to local stores by receiving recommended prenatal care for themselves and preventive services for their child. Members and providers can obtain Babies First brochures and coupons from Humana – CareSource.
If you provide OB or preventive services to Humana – CareSource members, you may be asked to validate coupons by members receiving service. Please call us if you would like a supply of Babies First coupons for your office.
Humana – 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.
Humana – 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.
As a provider for Medicaid consumers, you are required to identify the need for interpreter services for your Humana – CareSource patients and offer assistance to them appropriately. If you do not have access to interpreter services, contact Provider Services at call 1-855-852-7005.
Services Not Covered
If you have questions regarding services not covered, please call Provider Services at 1-855-852-7005.