...with CareSource and the service we provide. However, health partners who are unhappy with CareSource’s action concerning a medical necessity decision or a claim payment may appeal it. Please see...

...Comprehensive Formulary Last updated on 12/01/2025 For information about changes to our formulary, please review the Notice of Formulary Changes below. For the most up-to-date formulary information, use our online...

...VaxCare LARC Inventory Platform 04/12/2022 BH OAHP Readmission Policy 04/12/2022 Billing Updates: Duplicate Discharge Day Management/ICD-10 7th Character and Therapy Proposal 04/01/2022 Benefits of School-Based Health Centers for Ohio Students...

...forms. This form lets us work with a member’s caregiver. With the signed form, we can speak with a caregiver about a member’s payment or protected health information. Member Consent/HIPAA...

...The following is a list of available Prior Authorizations Forms: ABA Prior Authorization Form CES Waiver Prior Authorization Form Community Based/Behavioral Health Outpatient Prior Authorization Form EIDT/ADDT and ST/PT/OT Prior...

...to ask that your appeal be reviewed past the limit. How to Ask for an Appeal Online: Fill out the Coverage Redetermination Request Form. Phone: Call Member Services. Fax or...

Administrative Law Hearing Not happy with an internal appeal decision? You may ask for an Administrative Law Hearing. This is the next formal step. It involves you or your representative,...

The comprehensive formulary is a list of all drugs covered under your CareSource Medicare Advantage plan. The formulary consists of more than 3,000 medications. Additionally, CareSource provides monthly formulary updates...

...Member Appeals P.O. Box 1947 Dayton, OH 45401 Toll Free: 937-487-0629 (for Expedited Review) Fax: 937-487-0629 Expedited Fax: 937-531-2398 You may also use the secure online form on our Forms...

What is an Appeal? An appeal is when you ask us to review a decision that denied a benefit or service. The Appeal Process If you believe a decision we...