Sanjoy Musunuri joined CareSource in 2020 as Executive Vice President, Strategy and Business Development, where he oversees the advancement of new and innovative strategies that create growth opportunities and extend...

...business Corrective action of any identified fraud, waste and/or abuse are available in the provider manual. For provider terminations/suspensions information, see the CareSource Fair Hearing Plan (coming soon). Prohibited Affiliations...

...Department. If you would like to discuss an adverse decision with physician reviewer, please call the Utilization Management department at 1-800-488-0134 within five business days of the determination. Access to...

...15 business days then CareSource will provide a status update to the provider every five business days beginning on the 15th business day until the dispute is resolved. External Medical...

...adopt our policy on fraud, waste and abuse when handling CareSource business. The Federal False Claims Act Using the False Claims Act (the Act), you can help reduce fraud against...

...business day. CareSource® strives to make it easy for you to work with us, whether online or over the phone. For questions not addressed on our website, please call Provider...

...your busy schedule. Examples include: Contracting and Credentialing Screening, Brief Intervention and Referral to Treatment (SBIRT) Provider Satisfaction Surveys Provider Portal Early and Periodic Screening, Diagnosis and Treatment (EPSDT) Assignment...

...Management and Performance Improvement program includes both clinical and non-clinical services and is revised as needed to remain responsive to member needs, provider feedback, standards of care and business needs....

...discuss the utilization management (UM) medical necessity determination of a denial or decrease in level of care with CareSource’s Medical Director/Behavioral Health Medical Director or designee within five business days...

...Resources - UPDATE 01/05/2023 Readmission Pre-Pay Claims Review 01/03/2023 We strive to make partnering with us simple. We’re aware things may change in the way we do business with you...