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West Virginia
West Virginia

West Virginia Marketplace Plans

Payment Policies

Payment policies are designed to assist you when submitting claims to CareSource. They are routinely updated to promote accurate coding and policy clarification. These proprietary policies are not a guarantee of payment. Payments for claims may be subject to limitations and/or qualifications. Payment will be determined based upon a review of the actual services provided to a member and will be determined when the claim is received for processing. Providers and their office staff are encouraged to use self-service channels to verify member’s eligibility.

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

Current Payment Policies

PolicyEffective Date
Bilateral Procedures
Chiropractic Care
CPT Codes Not Covered in an Emergency Room Setting
Drug Screening Tests
Dry Eye Syndrome Testing
Family Planning
General Payment Methodology
Healthcare Acquired Conditions, Provider Preventable Conditions and Conditions Present on Admission
Low Vision
Mammography Services
Occupational, Physical, & Speech Therapy
Oxygen Delivery Systems & Supplies
Pass-Through Billing
Payments to Just4Me Out-of-Network Providers
Preventive Services and Sick Visit on Same Date of Service
Psychiatric Day Programs
Transcutaneous Electrical Nerve Stimulators (“TENS”)

Archived Payment Policies