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Quality Improvement
https://www.caresource.com/providers/education/quality-improvement/...health plan reporting, annual Healthcare Effectiveness Data and Information Set (HEDIS®). In addition, Marketplace members complete the annual Quality Health Plan (QHP) Enrollee Survey to capture member perspectives on health...
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Primary Care Provider Roles & Responsibility
https://www.caresource.com/providers/education/patient-care/pcp-roles-responsibilities/...CareSource of members who may benefit from case management. Please see the “Member Support Services and Benefits” section on how to refer members for case management. In addition, CareSource PCPs...
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Check Eligibility
https://www.caresource.com/providers/provider-portal/check-eligibility/...the member ID card is available in the Member ID Card Flier. Member Consent When you check eligibility on the Provider Portal, you can also determine if a member has...
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Provider Disputes or Appeals
https://www.caresource.com/providers/provider-portal/appeals/...CareSource determines, or the provider indicates in making the request on the member’s behalf or supporting the member’s request, that the standard resolution time frame could seriously jeopardize the member’s...
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Pharmacy
https://www.caresource.com/providers/education/patient-care/pharmacy/...if the member is suffering from a serious condition that requires urgent treatment. Members may also submit a formulary exception via phone, fax or an online form – Member Exception...
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Care And Disease Management
https://www.caresource.com/providers/education/patient-care/care-management-disease-management/...HNA included with their new member packet. It can be returned in the enclosed self-addressed, postage paid envelope. *The reward is issued through the MyHealth program. Members can find additional...
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Patient Administration
https://www.caresource.com/providers/education/patient-care/patient-administration/...members. CareSource PASSE members are informed of their rights and responsibilities via their member handbook. Please review our member rights and responsibilities and ensure your practice is in compliance. We...
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FAQs
https://www.caresource.com/members/education/faqs/...to the Member Handbook for a list of covered services. You can also ask your care coordinator or call Member Services to have a printed copy of the member handbook...
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Utilization Management
https://www.caresource.com/providers/education/patient-care/utilization-management/...Members may access Member Services by calling our toll-free number, 1-833-230-2099, 7 a.m. to 7 p.m. (TTY for the hearing impaired: 1-800-743-3333) and following the menu prompts. Members may access...
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Claim Rejection Notifications
https://www.caresource.com/providers/provider-portal/claims/claim-rejection-notifications/...mismatch How to Fix: Either the member had the wrong sex identified on the claim submission, or the member’s address on the claim does not match the member’s address in...
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