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Past Updates & Announcements
https://www.caresource.com/providers/tools-resources/updates-announcements/past/...Chain Reaction 09/22/2017 Clinical Appeals Require Member Consent 09/22/2017 Update on Processing Claims for Enhanced Ambulatory Patient Groups – UPDATE 09/01/2017 Drug Screening Reimbursement Policy – This notification has been...
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Provider Grievances
https://www.caresource.com/providers/provider-portal/provider-grievance/...payment dispute or appeals process. Providers have 30 calendar days from the date of the incident to file a provider complaint: HAP CareSource Attn: Grievances & Appeals P.O. Box 1025...
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Claims
https://www.caresource.com/providers/provider-portal/claims/...and/or appeals for denial of claims Get Paid Electronically CareSource has partnered with ECHO Health, Inc. to deliver provider payments. ECHO offers three payment options: Electronic fund transfer (EFT) –...
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Caregiver Forms
https://www.caresource.com/members/tools-resources/caregiver-resources/forms/...a grievance, coverage determination or appeal. Those not authorized under State law to act for the member will need to sign the form and mail it to the addresses below:...
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Comprehensive Formulary
https://www.caresource.com/plans/dsnp/pharmacy/drug-formulary/...our decision (coverage determination). If your coverage determination is denied, you can appeal the decision by asking for an appeal or redetermination of the original request. Full details on coverage...
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FAQs
https://www.caresource.com/members/education/faqs/...help doing 80 hours per month, you can ask for a reasonable modification. Can I appeal a decision about my eligibility or any decision that affects my coverage? Yes. If...
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Provider Overview
https://www.caresource.com/providers/...A Claim Provider Appeals Provider Appeals View appeal requirements and time frames and submit appeals. View or Submit Tools & Resources Tools & Resources Access information to help you with...
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State Fair Hearings
https://www.caresource.com/members/tools-resources/grievance-appeal/state-fair-hearings/...the Adverse Benefits Determination and Notice of Appeal resolution letters within 2 business days to the DHS Office of Appeals and Hearings. We will send an evidence packet to you...
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Drug Management Program
https://www.caresource.com/providers/education/patient-care/pharmacy/drug-management-program/...appeal. Refer to the plan’s Evidence of Coverage (Chapter 9) for information about how to ask for an appeal. The DMP may not apply to members that have certain medical...
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Behavioral Health Carve-In
https://www.caresource.com/providers/education/patient-care/behavioral-health-carve-in/...for residential and partial hospitalization Substance Use Disorder (SUD) services. Claims Appeals Information on how to dispute or appeal a claims decision can be found on CareSource’s Provider Appeals page....
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