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Great News Ohio Providers

Thank you for your participation with CareSource! We are committed to making it easier for you and your staff to work with us by implementing key operational improvements. Improvements include:

  • End to Primary Care Physician Rate Increases – As part of the Patient Protection and Affordable Care Act (ACA), the Primary Care Physician Rate Increases (PCRI) ended at the conclusion of calendar year 2014. This means that the federal government will no longer be financing the difference between the state Medicaid payment rate and the applicable Medicare rate. To receive payment inclusive of the rate increase, all eligible claims for PCRI must be clean and submitted to CareSource by May 1, 2015. You can find more information on PCRI at the Ohio Department of Medicaid website.
  • ICD-10 Compliance is now October 1, 2015 – Provider transition to ICD-10 coding for claims is to be complete on October 1, 2015. CareSource providers can access the latest updates and helpful information in the ICD-10 Resource Center. Check back often for updates.
  • Provider Portal – Save time and money by using the secure CareSource Provider Portal. This online tool lets you verify member eligibility, submit claims electronically, check claim status and more. To find out how you can get the most from the provider portal, please visit our Provider Portal webpage.
  • Provider E-Communication System – The CareSource Provider E-Communication System provides information electronically, but it is much more than just email. This system provides targeted information to specific individuals based on Provider type. Physicians, office managers and billing offices receive information specific to their needs. To begin receiving information electronically, register now!
  • Partnering with Providers to Increase Outcomes – CareSource’s community-based model is designed to improve the health outcomes of our highest-risk members. The community-based model includes a face-to-face visit with our member at least quarterly, ideally at the point of care. This extra support may increase compliance at office visits, decrease “no shows,” and help members maximize the benefits of a medical home. Read more on this program.
  • Health Homes – CareSource is proud to play a key role in care coordination for members with serious and persistent mental illness (SPMI). Through Ohio’s new Health Home program, mental health care providers partner with a primary care provider to deliver comprehensive care to members. CareSource provides a host of services to facilitate these unique partnerships. Learn more about our efforts to enhance behavioral and physical health care integration.
  • Flu Vaccines – CareSource will pay for members to receive flu vaccines at pharmacies. CareSource members who are 19 years of age and older may go to any CareSource network pharmacy that provides the vaccinations. A list of network pharmacies can be found on our Find a Pharmacy online tool. CareSource members also may continue to obtain their flu vaccine at their provider’s office. Members who are younger than 19 years of age should obtain their flu vaccine in coordination with the Vaccines for Children (VFC) program.
  • Electronic Funds Transfer – Electronic Funds Transfer (EFT) is now live for Ohio Providers! EFT is simple, convenient, reliable and secure. Enroll today!
  • Timely Filing Extended – Timely Filing for Ohio Providers has been extended from 180 to 365 days!
  • Clinical Tools Added – The CareSource Member Profile and Clinical Practice Registry can help you improve patient outcomes. These tools are on our secure Provider Portal.
  • Medical Policies – We've added Medical Policies on our website that provide guidance on determining medical necessity and appropriateness of care for a wide range of approved benefits.
  • Focus on Participating Hospitals – CareSource recently added a hospital phone queue as part of service operations to improve customer service to our participating hospitals. Simply call 1-800-488-0134.