Medicare

Medicare administrative policies apply to Medicare Advantage plans in all states and the MyCare Ohio (Medicare-Medicaid) plan.

Administrative Policies

Administrative policies offer guidance on determination of medical necessity, investigation and experimental services.

Policy Hierarchy

Decision making for Medicare Advantage is based upon the following hierarchy.

Policy

NCDs and LCDs can be found at www.CMS.gov. Please refer to the Coverage Determinations for Medicare Advantage policy for additional information on this process. The clinical rationale used by CareSource for making health coverage determinations is available by calling or faxing the CareSource Medical Management Department.  

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

Current Administrative Policies

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Archived Administrative Policies