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Ohio

Patient Care

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 Dental page provides information on providing dental services for our members.
  • 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 NavigateHealth Partner Manual.

Prenatal Services and Newborn Enrollment

Encourage CareSource members to see you as recommended for prenatal care! Your patients can enroll in the Babies First program by visiting our website.

Newborns whose mothers are members of our health plan are covered from the date of birth. In most cases, the newborn's name will appear on the PCP's member eligibility list for the month following the birth. Please contact Provider Services to verify eligibility. Please note that the mother must contact her county caseworker as soon as possible to establish eligibility for her baby.

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.

Cultural Competency

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.

Culturally and Linguistically Appropriate Services (CLAS) in Health and Health Care provide guidelines for individuals and organizations to implement culturally and linguistically appropriate services:

Interpreter Services

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. You may submit an NavigateInterpreter Service Request Form to request interpretation services on behalf of your patient.

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 1-800-488-0134.

Transportation

CareSource can provide transportation for our members’ appointments with participating health partners through our transportation vendors. Members can also get rides to Women, Infants and Children (WIC) appointments and redetermination meetings at the County Department of Medicaid. Each member can receive up to 15 rides to and from appointments (30 one-way trips) per 12-month period.


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).

CARE COORDINATION

CareSource encourages care coordination between primary care providers (PCPs) and behavioral health providers, in order to promote safe and effective care for your CareSource patients. Please use the following form to help facilitate communication: NavigateCoordination of Care Exchange of Information form